Your Information

Title:

 Mr.   Mrs.  Miss Ms.

Name: (required)

Email Address:

Contact Phone Number: (10 digits required)

New Service Location:

(Type Address, City, Zip)

Please List Other Adults You Would
Like to Add To This Account:

Current/Previous Telephone Company:

Current/Previous Telephone Number:

Current/Previous Address:
 (if different from above)

(Type Address, City, Zip)

Do you Own or Rent Property?

  Own     Rent

If you rent, Landlord's Name:

Landlord's Telephone Number:

Directory Listing

Name:

Address:

Directory Publishing

  Published (Free)
  Non-listed ($1.10 Per Month)
 Non-published ($2.50 Per Month)

Service Plans (Click each plan for a description)

 $19.95 Newton/Newtonburg; $20.90 Two Rivers

  $25.90 Newton/Newtonburg; $26.80 Two Rivers

  $35.90

  $39.59

  $49.95

  $69.95 Newton/Newtonburg; $59.95 Two Rivers

Service Plans and features do not include Interstate Access Charges, 911 Charges,
 Federal Universal Service Fund Charges and State & Federal taxes

Choose Features

Custom Calling Features:

  Automatic Callback $2.50
  Call Waiting/Cancel Call Waiting $2.55
  Call Forwarding $2.95
  Call Forwarding Remote Activation $1.00
 Caller ID with # Only $3.90
  Caller ID with Name and # $6.50
  Caller ID Block *67 - No Charge
  Caller ID Line Block $4.95
  Distinctive Ring $6.95
  Do Not Disturb $1.50
  Repeat Dialing $1.50
  RSVP Service $9.90
  Selective Call Acceptance $2.00
  Selective Call Rejection $2.00
  Speed Calling $.85 - $2.40
  Telemarket Block $4.95
  Three Way Calling $1.00
  Toll Control with PIN $2.95
  Voice Mail $4.95
  Voice Mail Enhanced with Paging $1.50 extra
  Voice Mail Enhanced with Multiple Mailbox $1.00 extra

Payment Options

  Automatic Withdrawal
  Online Payment
  Statement in Mail

  Yes No

Internet Services (We will contact you with the plans and price packages for your location)

I am interested in:

  Dial Up Internet Service
  DSL High Speed Service

How did you hear about Lakefield?

  Phone Book
  Newspaper Ad
  Radio Ad
  Internet Ad
  Referral
  Other

Comments

Do you have additional questions
or a comment?