Business Application Business Application Date: Date Format: MM slash DD slash YYYY Contact InformationApplicant Name:*Driver's License Number and State:Federal Identification Number:*Applicant Primary Email Address: Phone:*Employer:Date of Birth: Date Format: MM slash DD slash YYYY Employer Phone:*Deposit or Check:*Pay DepositLetter of CreditCredit CheckBill Format:OnlineCPNI Password:Email Address: Location InformationPhysical Service Address:*Mailing Address:*City:*City:*State:*State:*Zip:*Zip:*Primary Residence?YesNoLast Residence:Basic Service InformationExisting Customer?YesNoNotes:Existing Building/Location?YesNoNotes:New Service or Change to Existing Service?NewChangeI acknowledge that installation fees will apply* I, the undersigned, make application for the service and equipment, and additional service or equipment I may order later. The services and equipment are provided to me pursuant to all applicable All West tariffs, and the Terms and Conditions set forth at www.allwest.com. I agree to pay all amounts when due. Past due amounts are subject to a late payment charge of 1.5% per month. If All West 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.Applicant Signature:Co-Applicant Signature:Date: Date Format: MM slash DD slash YYYY Date: Date Format: MM slash DD slash YYYY Basic Phone Service is required, but all other services are optional.Internet ServiceEquipment Rental:*Rent Internet Equipment = $4.95Bundle Options$85.00 Mo, 5 MB internet, 3¢ LD, Phone, Caller ID$99.95 Mo, 10 MB internet, Unlimited Long Distance, Phone, Caller ID$115.00 Mo, 30 MB internet, Unlimited LD, Phone, Caller ID$115.00 Mo, 50 MB internet, 3¢ LD, Phone, Caller ID$130.00 Mo, 100 MB internet, 3¢ LD, Phone, Caller IDPhone ServiceNumber of Lines:Phone Number:Listed in Directory? (Non-Listed is $.50 per month)*YesNoCalling 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 Provider:Southern Montana TelephoneOtherNoneCalling Plans:200 Minutes Nationwide $5.00500 Minutes Nationwide $12.00Unlimited Montana $12.95Flate Rate $0.10Please upload a copy of your driver's license or other form of valid ID for verification purposes.*CAPTCHA
