Residential Application Residential Application Date: Date Format: MM slash DD slash YYYY Contact InformationApplicant Name:*Co-Applicant Name:Social Security Number:Social Security Number:Phone:*Alternate Phone:Date of Birth:* Date Format: MM slash DD slash YYYY Date of Birth: Date Format: 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 Check:*Pay DepositLetter of CreditCredit CheckBill Format:OnlineAccount Security 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 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.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 ServiceService Level:5 MB Internet = $60.0010 MB Internet = $75.0030 MB Internet = $90.0050 MB Internet = $105.00100 MB Internet = $120.00Equipment 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, 30MB Internet, Unlimited Long Distance, 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: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:Flat Rate 10¢ Minute$5.00 - 200 Minutes Nationwide$12.00 - 500 Minutes Nationwide$24.95 - Unlimited Nationwide CallingPlease upload a copy of your driver's license or other form of valid ID for verification purposes.*CAPTCHA
