Business Telephone Service Online Request

Use this form to initiate a request for resedential telephone service. Someone will contact you to begin setting up your service.

General Information

First Name: *
Last Name: *

Company: *

Service Address: *
City: *
Zip: *
Phone: *
Email:

*Flat Rate: $25.03/month ^{(rates may vary)}**
Connection Fees
Line Connection:	$15.00
Service Order Charge:	$20.00
Premise Visit (if needed):	$40.00
Inside Wiring Installation:	$60.00/hr

Type of Service:
Notes: