Residential Application Residential Application "*" indicates required fields Step 1 of 2 50% URLThis field is for validation purposes and should be left unchanged.Date: MM slash DD slash YYYY Contact Information Applicant Name:*Co-Applicant Name:Social Security Number:*Social Security Number:Phone:*Alternate Phone:Date of Birth:* MM slash DD slash YYYY Date of Birth: MM slash DD slash YYYY Driver's License Number and State:*Driver's License Number and State:Employer:Employer:Employer Phone:Employer Phone:Deposit or Credit Check:* Pay Deposit Credit Check Email Address to Use for eBills:*This email address will get all bills and notices from Southern Montana Telephone. Location Information Physical Service Address:* Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Mailing Address:* Same as previous Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Primary Residence? Yes No Last Residence:New Construction Yes No If new fiber construction is required, please be aware there will be a $250.00 setup fee due prior to starting construction.Basic Service InformationExisting Customer? Yes No Notes:Existing Building/Location? Yes No Notes:New Service or Change to Existing Service? New Change Installation Fees* I acknowledge that installation fees will apply. Customers can select internet services without selecting any phone services. Customers desiring both phone and internet service will find the most affordable rates by selecting a bundle option.Internet Service Minimum of 6 months consecutive service or a $211.00 fee may apply. Service Level None 10 MB Internet = $60.00 50 MB Internet = $80.00 250 MB Internet = $100.00 1 GIG Internet = $130.00 Router* Must use provided equipment from SMT Bundle Options Minimum of 6 months consecutive service or a $185.00 fee may apply. Bundle Options None $85 Mo, 10 MB internet, .03 per minute Long Distance, Phone, Caller ID $100 Mo, 50 MB internet, .03 per minute Long Distance, Phone, Caller ID $125 Mo, 250 MB Internet, .03 per minute Long Distance, Phone & Caller ID $155 Mo 1 GIG Internet, .03 per minute Long Distance, Phone & Caller ID Long Distance Bundle Add On $15.00 Add Unlimited Long Distance Phone ServiceNumber of Lines:Listed in Directory? (Non-Listed is $.50 per month)* Yes No Calling Features Call Waiting $1.50 Caller Identification (Name and Number) $5.00 Basic Voice Mail $3.95 Call Forwarding $1.50 Caller Identification on Call Waiting $2.00 Anonymous Caller Rejection $2.00 Three Way Calling $1.50 Long Distance ServiceSelected Long Distance: Flat Rate 10¢ Minute $5.00 - 200 Minutes Nationwide $12.00 - 500 Minutes Nationwide $24.95 - Unlimited Nationwide Calling I, the undersigned, make application for the services and equipment, and additional service or equipment I may order later. The services and equipment are provided to me pursuant to all applicable Southern Montana Telephone Service tariffs. I agree to pay all amounts when due. Past due amounts are subject to a late payment charge. If Southern Montana Telephone Company uses an attorney or collection agency to collect my delinquent account, I agree to pay all reasonable costs of collection or other action, including attorneys’ fees and costs. I have reviewed the SMT Acceptable Use Policy on SMT's website at www.smtel.com. Applicant Signature:Co-Applicant Signature:Date: MM slash DD slash YYYY Date: MM slash DD slash YYYY Please upload a copy of your driver's license or other form of valid ID for verification purposes.*Max. file size: 128 MB. Post Custom Field Password*Secret Question (select one):* The name of the city you were born in? What is your mother's middle name? What is your favorite pet's name? What is the name of the street you grew up on? What is the name of your childhood best friend? Answer:*Primary Customer Name:*Secondary Customer Name:Telephone*Authorized Contacts: Add RemovePrinted Name*Authorized Signature* Δ
