Business Application | Southern Montana Telephone

Date:

Contact Information

Applicant Name:*

Driver's License Number and State:

Federal Identification Number:*

Applicant Primary Email Address:

Phone:*

Employer:

Date of Birth:

Employer Phone:*

Deposit or Letter of Credit:

Pay Deposit

Letter of Credit

Credit Check

Bill Format:

Paper

Online

Both

CPNI Password:

Email Address:

Location Information

Physical Service Address:*

Mailing Address:*

City:*

State:*

Zip:*

Primary Residence?

Yes

Last Residence:

Basic Service Information

Existing Customer?

Yes

Notes:

Existing Building/Location?

Yes

Notes:

New Service or Change to Existing Service?

New

Change

I acknowledge that installation fees will apply*

Basic Phone Service is required, but all other services are optional.

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:

C0-Applicant Signature:

Date:

Internet Service

Rent or Purchase Equipment:

Rent Internet Equipment = $4.95

Purchase Internet Equipment = $150.00

Bundle Options

$85.00 Mo, 3 MB internet, 3¢ LD, Phone, Caller ID

$99.95 Mo, 5 MB internet, Unlimited LD, Phone, Caller ID

$115.00 Mo, 30 MB internet, 3¢ LD, Phone, Caller ID

$115.00 Mo, 10 MB internet, Unlimited Long Distance, Phone, Caller ID

$130.00 Mo, 100 MB internet, 3¢ LD, Phone, Caller ID

Phone Service

Number of Lines:

Phone Number:

Listed in Directory?

Yes

Calling Features

Call Waiting $1.50

Call Forwarding $1.50

Three Way Calling $1.50

Caller Identification (Name and Number) $5.00

Caller Identification on Call Waiting $2.00

Basic Voice Mail $3.95

Anonymous Caller Rejection $2.00

Long Distance Service

Selected Long Distance Provider

Southern Montana Telephone

Other

None

Calling Plans

200 Minutes Nationwide $5.00

500 Minutes Nationwide $12.00

Unlimited Montana $12.95

Flate Rate $0.10