Business Application Business Application Date: MM slash DD slash YYYY Contact InformationApplicant Name:*Driver's License Number and State:Federal Identification Number:*Phone:*Employer:Date of Birth: MM slash DD slash YYYY Employer Phone:*Deposit or Credit Check:* Pay Deposit Credit Check Bill Format: Online This field is hidden when viewing the formCPNI Password:Email Address:* Location InformationPhysical Service Address:*Mailing Address:*City:*City:*State:*State:*Zip:*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 I acknowledge that installation fees will apply* 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 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 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 ServiceMinimum of 6 months consecutive service or a $211.00 fee may apply.Service level: 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 OptionsMinimum of 6 months consecutive service or a $185.00 fee may apply. $85 Mo, 10 MB internet, .03 per minute Long Distance, Phone, Caller ID $100.00 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 $15.00 Add Unlimited Long Distance This field is hidden when viewing the form $115.00 Mo, 100 MB internet, 3¢ LD, Phone, Caller ID $100.00 Mo, 50 MB internet, 3¢ LD, Phone, Caller ID $85 Mo, 10 MB internet, .03 per minute Long Distance, Phone, Caller ID $15.00 Add Unlimited Long Distance Phone ServiceNumber of Lines:Phone Number: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 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 Please upload a copy of your driver's license or other form of valid ID for verification purposes.*Max. file size: 100 MB.CAPTCHA
