Name:
Place of Employment:
Employment Telephone #:
Social Security Number:
Driver’s License Number:
Marital Status:
Spouse Information
Name:
Place Of Employment:
Employment Telephone #:
Social Security Number:
Driver’s License Number:
Telephone Company Where you had previous service:
Your Telephone number was (is):
Credit Reference Name:
Address:
Telephone Number:
Service Name:
Mailing Address:
911 Address:
Directions to your location:
Do you wish for Ragland Telephone Company to do any inside
wiring?
Would you like to subscribe to station wire maintenance
@ .90 cents per month?
Please list any calling features listed above you
would like to subscribe to
Would you like Basic Area Calling (no charge to
you, only dial seven digit number for reduced rate)?
If so, would you like these calls listed on your
bill for an additional $1.75 per month?
Would you like Area Calling Plan 2 (flat rate fee
of $32.00 per month as described above)?
The amount of your deposit is determined by your
credit rating. Minimum deposit is $50.00.