Business Application for Service

Within the City of Burlington

(call to confirm availability at your location)

Plains Communication Services, LLC

6488 Highway 36, Joes, Colorado 80822

(voice) 970-358-4211 (fax) 970-358-4505

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

Will you be moving an existing telephone number to Plains? *

Yes Yes

Name of Applicant *

0/50 characters

Date of Birth *

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 $235.00). 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.

Signature *

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