|
|
Telephone
Service Request Form
|
|
Phone Number_______________________
| Name: |
____________________________________ |
| Service Address |
____________________________________ |
| Billing Address:: |
____________________________________ |
| City: |
____________________________________ |
| State: |
Iowa |
| Zip: |
____________________________________ |
| Social Security #: |
____________________________________ |
| Employer: |
____________________________________ |
| Previous Telephone #: |
____________________________________ |
Calling Features
|
| __________Wire Maintenance |
$1.50 |
| __________Call Waiting |
$1.00 |
| __________Call Forwarding |
$1.00 |
| __________3-way Calling |
$1.00 |
| __________Call Waiting, Call Forward, 3-way calling |
$2.50 |
| __________Unlisted Number |
$1.00 |
| __________Caller I.D. |
$3.95 |
| __________Voice Mail (Basic) |
$3.95 |
| __________900 Block |
$0.00 |
PIC Freeze
|
| __________ Yes, I would like Interstate Communications to
enact a "PIC Freeze" on any changes to my long distance carrier.
I understand that with the PIC Freeze in place, all requests
for long distance carrier changes will be rejected unless
notification is received by Interstate Communications from
the customer prior to receipt of such a request. (There
is not charge for this service.) |
Interstate Communications
Local Fees ~ Monthly
|
| __________City Residence |
$13.00 |
| __________Rural Residence |
$13.00 |
| _____X____Includes Single Line Access Fee |
|
|
Interstate Communications
Business Service~ Monthly
|
| __________City Business |
$20.25 |
| __________Rural Business |
$20.25 |
| _____X____Includes Multi Line Access Fee |
|
|
Long Distance
|
| I choose the following company(ies) as my long
distance carrier(s): |
Name of Inter LATA Carrier: _____________________ |
CIC Code _____________ |
| |
|
Name of Intra LATA Carrier: _____________________ |
CIC Code _____________ |
Agreement
|
| In making this Application, the undersigned agrees
to the rules and regulations of Interstate Communications
as set forth in this tariff and Communications Policy, and
to the general changes in rules or rates for the service furnished
under this Application. |
| Applicant's Signature: |
_________________________________ |
| Application Taken By: |
_________________________________ (emp initials) |
| Date: |
___________/__________/___________ |
|
|
