Residential Application DiscoverQuality Home Phone Services at Rock-Bottom Rates 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 This field is hidden when viewing the formAccount Security 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 acknowledge that installation fees will apply*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: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 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. 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 Please upload a copy of your driver's license or other form of valid ID for verification purposes.*Max. file size: 100 MB.CAPTCHA
