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Residential Application for Service
Within the City of Burlington
(Call to confirm availability at your location)
Plains Communication Services, LLC
6488 US Highway 36, Joes, Colorado 80822
(voice) 970-358-4211 (fax) 970-358-4505
(email) plains@plainstel.com (website) www.plainstel.com
Current Telephone Number
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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.
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No
Yes
Yes
Name of Applicant
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0/50 characters
Date of Birth
Social Security #
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Service Address, City, State, Zip
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Mailing Address, City, State, Zip
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Previous Address, City, State, Zip
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Employer and Work Phone #
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Cell Phone #
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Nearest Relative Not Living with Applicant, Phone #, Address, Relationship to Applicant
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Signature
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