Application Business - New Business Telephone Only

Business

Phone Only
All questions marked with * are required.
Please specify the Customer Care Specialist that you spoke with
Please specify the Customer Care Specialist that you spoke with*

Amy CAngie TConnie CDebbie POther
Schedule of Charges:

Basic Phone: $34.95 monthly plus taxes & fees

Installation: $100.00
Business Name*
if DBA, please enter your full legal name below
Full Legal Name

PrefixFirst NameMiddle NameLast NameSuffix
Contact Number*

Area CodePhone Number
Is this a*

Home PhoneCell PhoneWork Phone
E-mail
Service Address*

Street Address

Street Address Line 2

CityState

Zip Code
County*
Do you Own or rent this property?*

OwnRentOther
If renting, please provide Landlord Name and Contact #
Do you wish to sign up for eBill (paperless) billing?*

Yes, I want to sign up for eBill and receive a paper statementYes, I want to sign up for eBill and go paperlessNo, I do not want to sign up for eBill. I wish to receive a paper statement in the mail.
Billing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Alternate name and contact #*
Have you had service with our company before?*
Has there been service at this address before?*
Do jacks need to be installed? *if no, select 0, if yes, select # of jacks*
Is electric run to the property?*
Where is your electric meter located?*
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
Please list any other individuals you are granting permission to access this account*
Separate multiple names with comma ,
Signature

Clear
Should be Empty:

Business

All questions marked with * are required.