Application - New Telephone Only Service

Telephone Service Only
All questions marked with * are required.
Account # (For Business use only)
Please specify the Customer Care Specialist that you spoke with
Basic Telephone Service is $22.75/month *excluding taxes and fees

Schedule of Charges:

Connection Fee $50.00
Full Legal Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Social Security #
Service Address

Street Address

Street Address Line 2

CityState

Zip Code
Do you wish to sign up for eBill (paperless) billing?
Billing Address (if different from Service Address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County
Subdivision
Contact Number

Area CodePhone Number
Is this a..
Contact Number

Area CodePhone Number
Is this a..
E-mail
Do you Own or rent this property?

Other
If renting, please provide Landlord Name and Contact #
Spouse Name (or other name on account)

First NameLast Name
Spouse Contact Number

Area CodePhone Number
Spouse Date of Birth

MonthDayYear
Employer?
Please select the features (if any) you would like to add to your service
CPNI

CPNI is a communications industry abbreviation that stands for Customer Proprietary Network Information. CPNI refers to your telephone service, including the charges on your bill, the services you subscribe to, and your usage data and calling patterns.

For more information, please click here to read the CPNI guide lines.
Please list any other individuals you are granting permission to access this account
Separate multiple names with comma ,
For account security, please select a secure question to answer:
You will answer this question below.
Please answer your question above
Please answer the question you selected above
SERVICES REQUIRE ELECTRICITY AT THE CUSTOMER’S SERVICE LOCATION. IF AN ELECTRICAL SERVICE OUTAGE OCCURS, BROADBAND AND TELEPHONE SERVICES WILL NOT FUNCTION DURING THE OUTAGE PERIOD.
Signature
REVISED 2/27/2025
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Telephone Service Only

All questions marked with * are required.