OFFICE USE ONLY

Issue Trak # Date:

Verification of the Current Customer

Please provide your initials next to what was verified:

SSN DOB:

TWC PIN DL#/Gov. ID:

Verification of the New Customer

Account Assumption FormSSNDOB:

Account StandingDL#/Gov. ID:

Please provide your initials that the new customer was provided with a WelcomeKit including the Subscriber Agreement and Privacy Notice:

_

SECTION 1: Current Account Holder

Name: Account #: _ Home Phone:

Service Address: _

SECTION 2: New Account Holder

Name:

Billing Address:

Home Phone: Alternate Phone:

SECTION 3: Existing Account Services Internet Cable Phone Security WHDVR HBO SHO MAX Total Monthly Charges: $

Other (list)

Existing Equipment:

Equipment Type (Modem, Box, Router) Equipment Serial Number or MAC Address

SECTION 4: Directory Listing (New Account Holder)

Directory Information - For Home Phone Service Only Listed Private (if Private, skip to next section)

Directory Listing: (exactly as it will appear in a listing) Phone Number:

Name:

Address:

SECTION 5: Important Information about your Account Assumption request

IMPORTANT INFORMATION!!

The new account holder will not have access to, or receive any information concerning previous account oraccount holder information:

If VM services exist, VM service will be disconnected and a new VM box will be established; any messages saved for the currentcustomer will be lost once the request for Account Assumption is processed.If an e-mail account exists, all E-mail accounts will be disconnected and a new e-mail account will be established; any e-mails for thecurrent customer will be lost once the request for Account Assumption has been processed.Although an effort is made to ensure that campaigns and promotions are carried over, it is not guaranteed that these promotions will beavailable upon processing the request.

Change will be completed within 5 business days from receipt of form.

SECTION 6: Authorization and Acceptance of Account Assumption - Signatures

Please read the following and sign below:

Current Account Holder Authorization for Transfer of Account Services: I hereby authorize the transfer of my Time Warner Cable Servicesto the New Account Holder listed above. I understand that the New Account Holder will assume all responsibility for the Time Warner CableServices received at the Service Address listed above under the terms of the Subscriber Agreement I entered into.

New Account Holder Acceptance of Transfer of Account Services: I hereby agree to assume responsibility for the Time Warner Cable Servicesat the Service Address listed and agree to be bound by the terms of the Subscriber Agreement entered into by the Current Account Holderincluding those terms indicating that any disputes arising under such agreement will be resolved by arbitration. I agree that I am responsible for allcharges including any past due balances. I agree that my assumption of the Account services is effective as the date signed below.

Further, I agree that as indicated in the Time Warner Cable Subscriber Agreement, I am responsible for the Time Warner Cable Equipment, including any loss and damage, normal wear and tear excepted. I understand a credit inquiry is performed to verify my identity and to prequalifyfor services. Time Warner Cable may require that I pay a deposit prior to activation of service(s) based on the results of the credit inquiry, if my credit status changes, or if I fail to keep my account current. Deposits will be refunded, less any amounts due to Time Warner Cable, within forty-five (45) days of account termination and return of Time Warner Cable equipment if any, or otherwise as required by applicable law.

The current Time Warner Cable Subscriber Agreement, Privacy Notice and other policies can be found at:http://help.twcable.com/html/policies.html

Acceptance of Account Services: I understand am taking responsibility for the existing service, that I am subject to the Time Warner CableSubscriber Agreement, and hereby authorize all account services to be placed under my name. I understand that I am responsible for all charges, and any balance due on the account.

Notice Relating to 911 Services: The Home Phone voice-enabled cable modem is electrically powered and, in the event of a power outage or TimeWarner Cable network failure, Enhanced 911 services may not be available. The Time Warner Cable Terms of Service prohibit moving the voice-enabled cable modem to a new address. If you do so, Enhanced 911 services will not operate properly as emergency operators will be unable toaccurately identify the caller's address in an emergency. If you would like to establish service at a new address you must call Time Warner Cable.

Care of Equipment: Customer is responsible for Time Warner Cable’s equipment and its return to Time Warner Cable and shall bear all risks ofloss and damage to it including fire, theft, lightning and any acts of nature, except such as may be due to normal wear and tear. Customer agreesnot to and not to allow others, to tamper with, alter or services such equipment or to remove it from the point of initial installation.

Current Subscriber’s Signature: Date:

New Subscriber’s Signature: _ Date:

SECTION 7: Notarization

Notary: If returned via e-mail, U.S. Postal Service, or fax, notarization is required with accompanied documentation. Notary cannot be AccountHolder or Authorized User of current or assumed account.

Notary Signature:

Date ofNotary:

Notary Seal:

Mailing addresses of local TWC Stores can be found at www.twc.com/stores