Application For Telephone Service

Applying for Telephone Service

Application For Telephone Service

Please note: Although it is most unlikely that you will experience any problems responding to this form, certain non-standard browsers will not respond properly. If you experience any difficulties, (or if your are not using a forms-capable browser) you may email your response to: questions@newhopetel.com

Last Name:

First Name:

(Street Address is for the location that you are applying for service)

Street Address Line 1:

Street Address Line 2:

City:

Zip Code:

Mailing Address Line 1:

Mailing Address Line 2:

City (Mailing Address):

State:

Zip Code (Mailing Address):

Current Phone Number:

Contact Phone Number:

A Customer Service Representative will need to call you. What is your preferred time to receive this call (must be 8:00 am - 12 noon or 1:00 pm - 4:30 pm).

Time to Call:

Social Security Number:

Drivers License Number:

Birth (Month/Day/Year):

Employer Name:

Employer Address Line 1:

Employer Address Line 2:

Employer City:

Employer State:

Employer Zip Code:

Employer Phone Number:

Employment Years:

Employment Months:

What type of service are you applying for?

Do you want your name and number published in the directory?

If yes, enter how you want the listing to appear.

Directory Name:

Directory Address:

Do you want your number listed in directory assistance?

Select calling features,other features may be available, ask Customer Service Representative for a complete listing

Automatic Callback	Automatic Recall	Call Forward Busy
Call Forward No Answer	Call Forward All	Call Waiting
Caller ID	Three Way Calling	Selective Call Acceptance
Selective Call Forwarding	Selective Call Rejection	Toll Control with PIN
Teen Service	(Multiple items may be chosen)

Are you interested in New Hope Telephone Internet Service?

Please be aware that payments are due by the 24th of each month. Payments received after the 24th will result in a 1.5% late fee per month (which is an annual percentage rate of 18%).

In addition, payments not received within 45 days of bill date will result in disconnection of your service. If your service is disconnected, you will be responsible to pay the amount owed plus a $25.00 reconnection fee and a $75.00 deposit.

If payment has not been made within 15 days of disconnection, the account will be considered delinquent. In the event this account becomes delinquent, the customer shall pay all of the attorney fees and costs associated with collection of the account plus all attendant collection fees whether litigation is initiated or not.

Notes:

Date:

By clicking the Submit button, you are indicating that you have read, understood and agreed to the information provided.

NEW HOPE TELEPHONE COOPERATIVE DOES NOT DISCRIMINATE AGAINST APPLICANTS ON THE BASIS OF SEX, MARITAL STATUS, AGE (EXCEPT UNDER AGE 18), RACE, NATIONAL, ORIGIN OR RELIGION. (THE FEDERAL AGENCY WHICH ADMINISTERS COMPLIANCE WITH THIS LAW IS THE EQUAL CREDIT OPPORTUNITY, FEDERAL TRADE COMMISSION, WASHINGTON, D.C. 20580)