Application Date:                   Desired Service Date:

Contact Number:           Contact Email:                        

Applicant's Name: 
Social Security #:            

Driver's License #: 

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: $0.50/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 $1.65 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:  

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

Requested Service:

  Phone Only
  $34.95  Internet (without Pride Plan) - must subscribe to Local Phone
  $35.95  Simple Solution  (Phone, Simply Basic CATV, Federated LD & Feature Bundle)
  $60.95  Basic Solution  (Phone, Basic CATV, 20M* Internet, Federated  LD & Feature Bundle)
  $47.95  Surfer Solution  (Phone, 20M* Internet, Federated LD, & Feature Bundle)
  $67.95  Connected Solution  (Phone, Simply Basic CATV, 20M* Internet, Federated LD & Feature Bundle)
  $90.95  Scholar Solution  (Phone, Basic CATV, 20M* Internet, Federated LD & Feature Bundle)
  $121.95  Family Solution  (Phone, Basic CATV, 20M* Internet, Unlimited** Federated LD & Feature Bundle)

Agreement to Purchase Communication Service(s):
Services Requested: Please check all that apply
  Local Phone                                 High-Speed Internet
  Cable TV                                     Premium Cable TV Package

Commencement date and period of service: The service activation fee(s) will be waived upon installation of each service, if customer agrees to continue service for a minimum period of twelve (12) months. After expiration of the minimum period, customer may cancel service(s) at any time on thirty (30) days notice to FTC.

If customer chooses to add additional service(s) at a future date, the current activation fee(s) for the additional service(s) will apply or customer can choose to sign a new contract for all subscribed services. If customer chooses to sign a new contract, this existing contract would be void and the new contract period would commence for all services at that time.

Breach of Contract: If, for any reason, customer cancels any service selected above prior to the expiration of the minimum period or if service is terminated by FTC prior to the expiration of the minimum period as a result of customer's breach of the obligations set forth herin, the customer will be obligated to pay the Activation Fee(s) for each service requested above. The activation fees for each service are as follows:

Local Phone Activation - $40.00                 High-Speed Internet Activation - $175.00
Basic Cable TV - $35.00                               Premium Cable TV Package - $58.00

  I AGREE TO PURCHASE SERVICES UPON THE ABOVE STATED CONDITIONS.
 I will pay the activation fee(s) for all requested services before they are installed.

Internet Information:

Username:  @fedtel.net

Password:   
(at least 8 characters - must include at least one uppercase and one number. Cannot include username in password)

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: $25 install - free            Block all Long Distance - free

Additional Phone Features:

• “Caller ID service is susceptible to fraud known as Caller ID ‘spoofing.’ Disreputable persons can deliberately falsify the Caller ID number to disguise the identity of the caller. Congress is currently considering new laws to take action against spoofers. More information is available at “fcc.gov” Search for ‘spoofing’.”

Federated Long Distance
Federated  is your long distance company, saving you money while doing business with people you know and trust.
Option 1: .14 cents per minute:
Option 2   60 Minutes of LD = $5.95
Option 3   350 Minutes of LD = $26.95
Option 4   Unlimited** Long Distance = $36.95          
  Other:  View Long Distance Ballot
 

Cable TV Optional Choices: View Channel Line Up
Simply Basic Only (channels 2-13) - $20.77
Basic Cable (channels 2-61) - $47.41*
      
Each of the following Digital Premium Channels require the use of a Digital Set Top Box or DVR Box. Must subscribe to Basic Cable to receive Premium Channels.
Digital Choice Channels & DMX Music Channels - $10.95/month  (52 additional channels)
HBO/MAX Plus Premium - $19.05/month
ENCORE/STARZ Plus Premium - $10.95/month
The Works (Digital Choice, DMX Music & All Movie Channels) - $ 36.75/month
# of Set Top Boxes - $5.00 per box/month
# of Digital Video Recorder (DVR) Boxes - $12.00 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 an advanced payment of $150.00, which consists of: $100 deposit, $35 Basic Installation Fee, and $15.00 for one month of service in advance. Please select one of the following:

  I will pay a deposit

  I will email Federated Telephone my credit reference

  I will mail Federated Telephone my credit reference

Data Collection Information:

As recipients of federal assistance, Federated Telephone is required to identify and document as accurately as possible the racial/ethnic and gender data on the eligible population in our service area. You are not required to furnish this information, but are encouraged to do so. The requires that Federated Telephone may neither discriminate on the basis of this information nor on whether you choose to furnish it. However, if you choose not to furnish it, under Federal regulations, Federated is required to note race/ethnicity on the basis of visual observation or surname. We would appreciate your checking the appropriate group listed below. The information you provide will ONLY be used for Federal Government Reporting Purposes.
 

Ethnic Information:
White American Indian/Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other
I do not wish to furnish this information.

Gender Information:
Male Female
I do not wish to furnish this information.

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