24-7 Telcom Logo
Residential Local Phone Service Application


912 Crescent Street, Menomonie WI, 54751
Phone: 715-231-2000
Fax: 715-231-2407                               
Customer Information

What type of service are you requesting?
New Connection Changing Provider Additional Line Change Phone Number Moving Service

Residence Is: 
Your Name___________

Social Security #___

Company Name________

Service Address_____

City________________

State_______________ ZIP

County______________

Telephone number____

Email address_______
Date you need Service______________

Will jacks and/or wiring be needed at this location?
(Labor rates will apply):   Yes No
Current Services w/24-7 Telcom:
Internet
Voice Mail
Paging
Cellular
Other
Billing Information (if different from above)
 
	Billing Contact___

	Mailing Address__

	City_____________

	State____________

	ZIP______________

	County___________
Would you like one of these Billing Services:
Telephone Service Details
Main Line 2nd Line 3rd Line 4th Line
Current Phone Number
Assign New Number? Yes Yes Yes Yes
Calling Features and Package Plans
Basic Connection
Includes Phone Line & Unlimited Calling
Customer Choice I
Basic Connection, 1 Calling Feature & 1 Specialty Feature
Customer Choice II
Basic Connection, 2 Calling Features & 2 Specialty Features
Main Phone Line Do Not Need
This Line		 YES YES YES
2nd Phone Line Do Not Need
This Line		 YES YES YES
3rd Phone Line Do Not Need
This Line		 YES YES YES
4th Phone Line Do Not Need
This Line		 YES YES YES
* Connection Charges Main Line 2nd Line 3rd Line 4th Line Other
* All telephone lines are subject to a $6.00/month Subscriber Line Charge plus any applicable taxes or any Local, State, or Federal charges.
Available Calling Features
Available Specialty Features
Calling Features
Main Line
2nd Line
3rd Line
Calling Features
Main Line
2nd Line
3rd Line
Call Waiting
CallerID/Call Waiting
Call Forwarding
Caller ID Number
Call Forward Busy
Caller ID Name/Number
Call Forward No Answer
Automatic Recall
Three Way Calling
Automatic Callback
Deactivate Call Waiting
Select Call Accept
Speed Call 8
Select Call Forward
Speed Call 30
Select Call Reject
Toll Restriction
Select Distinct Ring
Message Waiting Lamp *
Teen Line
Stutter Dial Tone *
Voice Mail
* Only Available on a 231-XXXX phone number
Wire Maintenance
Long Distance Options
You must choose a Long Distance Carrier or you will not be able to place long distance calls.

Interlata Carrier:      Intralata Carrier: 
Would you like Calling Cards?
No Yes    How Many?  		800/888 Number:
No   Yes
Long Distance Access Codes:
No Yes   How Many?  		Toll Blocking (Free of Charge):
900 Numbers   Collect Calls   Third Number
Long Distance Freeze (Free of Charge)* Yes   No:
*Your long distance can not be changed unless you give handwritten permission to our office.
Directory Listing (as it should appear in the directory)
Main Directory Listing

Name:_____
Address:____

 Yes - Omit Address from Directory.
Additional Directory Listing

Name:_____
Address:____
Directory Information
Published
Unlisted
Unlisted/Unpublished
Main Phone Line: Do Not Need
This Line		 YES YES YES
2nd Phone Line: Do Not Need This Line YES YES YES
3rd Phone Line: Do Not Need This Line YES YES YES
4th Phone Line: Do Not Need
This Line		 YES YES YES
Advanced Payment Information

A $50.00 Advanced Payment is required prior to telephone service being connected.

NOTE: The Advanced Payment will be applied to the 1st month's bill.

Comments
I, the Applicant, am requesting that 24-7 TELCOM furnish telecommunication services to the Applicant subject to the following terms and conditions: Through my signature below, I verify that I am authorizing 24-7 TELCOM to become my new primary carrier for the provision of Telecommunication services. I authorize 24-7 TELCOM to act as my agent to achieve this change, and direct my current primary carrier to work with 24-7 TELCOM to accomplish this change.

I understand that my previous local service provider will charge me to switch providers and should I desire to return to my former carrier, I may be required to pay an additional charge to reconnect to that company. I also understand that my new primary carrier may have different calling areas, rates and charges than my current primary carrier, and that by signing below I indicate that I understand those differences (if any) and am willing to be billed accordingly.

I accept full liability to pay all charges incurred in using this service. I understand that an early termination fee may apply. I understand that installation may take up to 5 business days.

I grant to the 24-7 TELCOM a right-of-way easement to construct operate; maintain a telecommunications line or system on my premises and in or upon all streets, roads or highways abutting the above premises, and also the right to cut or trim trees and to bury cable necessary to the efficient operation of the system.

I certify that I am at least eighteen years of age and that I have read and understand this letter of agency and that I am authorized to change telephone companies for services to the telephone number(s) listed above. I am further authorizing 24-7 TELCOM to obtain billing information, customer service reports, and to obtain reports from credit references or credit agencies.


Customer Signature __________________________________

Date __________

24-7 Telcom
912 Crescent Street
Menomonie, Wisconsin 54751

Phone (715) 231-2000 -- Fax (715) 231-2407