Residential Application Residential Application Date: MM slash DD slash YYYY Contact InformationApplicant 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 Bill Format: Online Account Security Password: Email Address: Location InformationPhysical Service Address:* Mailing Address:* City:* City:* State:* State:* Zip:* Zip:* Primary Residence? Yes No Last Residence: 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 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: MM slash DD slash YYYY Date: MM slash DD slash YYYY Basic Phone Service is required, but all other services are optional.Internet ServiceService Level: 5 MB Internet = $60.00 10 MB Internet = $75.00 30 MB Internet = $90.00 50 MB Internet = $105.00 100 MB Internet = $120.00 Equipment Rental:* Rent Internet Equipment = $4.95 Bundle 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 ID 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 Please upload a copy of your driver's license or other form of valid ID for verification purposes.*Max. file size: 100 MB.CAPTCHA
