Telephone Services Application

Name(s):

____________________________________   

Current/Future Address:

____________________________________
____________________________________

Billing Address if different:

____________________________________

____________________________________
Current Telephone: ____________________________________

Alternate

Telephone: ___________________________

Date for Activation: ____________________________________  
Telephone Service Desired:  Please check all that apply.
Telephone Service Business_______ Residential _______
Voicemail Basic_______       Advanced_________
Optional Features: Caller ID, Call Waiting, Call Waiting with ID, Call Forwarding, Block Telemarketing, Speed Dial 8, Speed Dial 30 Prices range from $1.00 - $3.00 per feature                      

_______________________________

_______________________________

_______________________________
Other Features requested   ___________________________________________________________
Published number ____________or non-published number __________

LaMotte Long Distance:

Basic Plan: 12 cents per minute out of state/ 16 cents per minute in state      ___________

Discount plan: $4.95 month, 7 cents per minute out of state/ 10 cents per minute in state __________

Name of Other Long Distance Carrier ____________________  If you select this option please contact the Carrier and ask them to bill you directly.
No Long Distance ____________  
________________________________________________________________________________
La Motte Telephone Company offers the following additional services, please place a check mark next to any services you are interested in:
Internet: Dial Up ______ DSL ______ WiFi (Bellevue only)_____
Cellular Service through ______

For office use only:

Assigned Telephone Number:_______________________________

Security Deposit:____________________ Activation Fee____________________

Date of Activation:________________________________________

 
LaMotte Telephone Co - WiFi - PO Box 8, LaMotte, IA 52054
Phone: 1-866-943-4375 Fax: 563-773-2345 Email: Info@lamotte-telco.com