Application Date:                   Desired Service Date:

Contact Number:       Contact Email:                         

Applicant's Name: 
Social Security #:  

Co-Applicant's Name: 

Service Address: 
                           
                           

Own:         Rent:        Landlord: 

Billing Address:    
                            
                            

Has either the applicant or co-applicant had telephone service with Federated Telephone before?
No:        Yes:      If Yes, under what name? 

How should your name appear in the directory?    

Additional listings, per listing: $0.65/month  
  Unlisted #: $1.25/month    

We offer a maintenance agreement whereby we will provide all maintenance service for residential subscribers to repair any damaged inside telephone wire.  You will be billed at a monthly rate of $3.55 per access line.  This will be included on your monthly telephone bill.  If a selection is not made, we will assume you have chosen to take the maintenance agreement.

Yes:      No:  (by checking no, you assume full responsibility for maintenance of your own inside wire.  Federated Telephone will repair for a service fee, based on time and materials.)

Under the penalties of service disconnection or immediate deposit request, I declare that I have examined and completed this application and the information I have given is true, accurate and complete.  I will assume all responsibility for all charges for this phone service.  I agree to the rules and regulations of Federated Telephone as set forth in the Exchange Tariff and to any general changes in the rules, regulations, tariffs or rates for the service furnished under this application.

I further agree to provide a 110 outlet for power to the Universal Demarcation Point (UDP) and I assume responsibility for the cost of electricity.  

Applicant's Signature:              Date:  

Co-applicant's Signature:              Date: 

********************

Requested Service:

  $14.40  Phone Only
  $42.95  Basic Solution  (Phone and Cable)
  $42.95  Surfer Solution  (Phone and Internet)
  $58.95  Tech Solution  (Cable and Internet)
  $69.95  Scholar Solution (Phone, Cable, and Internet)
  $99.95  Family Solution  (Phone, 400 Minutes Long Distance, Cable, and Internet)

Internet Information:

Username: 

Password:   
(at least 6 characters - letters and/or #'s. Cannot include username in password)

Equipment/Set Up Fee Options (Does not include inside wiring):  
Pay up front $129.95     Waive with 12 Month Agreement * (Click here to View)
* 9 Month agreement for students with valid Student ID

Internet Service Agreement & Acceptable Usage Policy (Click here to View)
 I have read and agree to all terms and conditions of the Internet Service Agreement/Acceptable Usage Policy

Line Restrictions:
Please check the restrictions you would like on your line:
  Block 900 numbers - free                            Collect Call Block - free
  Toll Restriction with PIN: $3.15/mo            Block all Long Distance - free

Additional Features:

Solutions Long Distance
Federated  is your long distance company, saving you money while doing business with people you know and trust.
One low rate of .10 cents per minute: no monthly charge                   
  One low rate of .07 cents per minute:  $3.95 monthly charge
  Other: 
 

Cable TV Optional Choices: View Channel Line Up
(Channels 2-61 are included in the Packages)

Each of the following Digital Premium Channels require the use of a set top box - $5.00/month.
Digital Choice Channels & DMX Music Channels - $10.95/month  (52 additional channels)
HBO/MAX Plus Premium - $13.95/month
MOVIE/SHOW Plus Premium - $12.95/month
ENCORE/STARZ Plus Premium - $10.95/month
The Works (includes Digital Choice, DMX Music,- $41.96/month
# of Set Top Boxes - $5.00 per box/month

Comment/Notes:

Credit Reference

Federated Telephone needs to be provided with a credit reference from a previous utility provider. Do not send a copy of a bill. This must be a credit reference showing 12 months of payment history. If a credit reference is not provided, you will be asked to pay a $100 deposit. Please select one of the following:

  I will pay the $100 deposit

  I will email Federated Telephone my credit reference

  I will mail Federated Telephone my credit reference

By clicking on the submit button, I accept the terms of this agreement.