Business Application for Service

Within the City of Wray

Plains Communication Services, LLC

29360 US Highway 34, Wray, Colorado 80758

(voice) 970-592-2211 (fax) 970-592-2212

(email) plains@plainstel.com (website) www.plainstel.com

Will you be moving an existing telephone number to Plains?

It's important that you don't disconnect any existing service until you have spoken with us. We'll walk you through the process. If you want to keep your existing number to transfer (port) it to Plains for service, the number must be active. A disconnected number is not available for porting to Plains and will be lost. *

Yes Yes

Name of Applicant *

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Name of Business *

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Date of Formation *

Federal ID # *

Service Address, City, State, Zip *

Mailing Address, City, State, Zip *

Contact Telephone # *

What is the nature of your business? *

Everything that I have stated in this application is correct to the best of my knowledge. I authorize Plains Communication Services, L.L.C., to check my credit history through Online Utility Exchange and to answer future questions about its credit experience with me. (The amount of the deposit which may be required of an applicant for the purpose of establishing credit shall be $250-$500 based on credit history). Note: All personal information Plains Communication Services, L.L.C. accumulates pertaining to your account is available to you, the applicant, at any time.

Plains Communication Services, LLC, service is for a minimum of 24 months following installation (i.e. the commitment period). If service is disconnected before the commitment period is complete, a $200 service charge will apply. A $25 late fee will be assessed when bill is 30 days past due.

Signature *

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