Poka Lambro Telephone Cooperative, Inc. is a non-profit telephone cooperative corporation under the Texas Telephone Cooeprative Act. Poka Lambro Telephone Company is a wholly owned subsidiary of Poka Lambro Telephone Cooperative. For the purposes of obtaining services via this application, either company (dependent on service area) will be referred to as Poka Lambro.

Monthly billings for service will include charge for phone and/or internet service, applicable sales tax, 911 charges, access recovery charges and federal/state universal service charges as well as any other applicable fees and/or charges. Your first billing statement will be prorated from the date service is connected and will include the next month in advance.

If your service is disconnected for non-payment in the future, a reconnection fee of $23.00 will apply to reinstate service.

Outstanding Debt: Poka Lambro may take any allowable legal action, or employ a collection agency, to pursue the collection of any outstanding debts owed to Poka Lambro. In the event that you, the customer, incur an oustanding balance with Poka Lambro that remains unpaid and is referred for collection, you shall also be held responsible for an attorney fees, charges, or costs associated with the collection. This responsibilty is in addition to any principal, interest, or fees owed on the account.

Application for service. Please complete each section and electronically sign where indicated. A valid form of identification may be required.

Promo Code

Date of Application *

Type of application *

Residential

Business

Service Area/Community *

Type of residential account? *

Individual

Joint

Type of business account? *

Is this account tax exempt? *

No

Yes (please indicate exemptions i.e. State, Federal, 911, TX USF and/or FUSF Yes (please indicate exemptions i.e. State, Federal, 911, TX USF and/or FUSF

First Name (as it will appear on the bill) *

Last Name (as it will appear on the bill) *

Joint Applicant Name *

Company Name *

Contact Name *

Physical address of location service is requested for (911 address): *

Date of Birth *

Billing Address (if different than service address)

City *

State *

Zip Code *

Best Telephone Number To Reach Me *

Drivers License Number *

Social Security Number *

Email Address *

Joint Applicant Social Security Number *

Joint Applicant Birthdate *

Joint Applicant Drivers License Number *

Tax ID Number *

INTERNET SERVICE

Do you want Internet Service? *

Yes

No

I want Internet *

	Broadband Internet Packages
Choose the speed/rate

I want business Internet service *

	Broadband Internet Packages
Choose the speed/rate

Please note: High Speed Internet Service is subject to location and network availability. Not all speeds are available in all areas. Speed is not guaranteed as multiple factors may impact the users experience. Any applicable taxes, fees or charges apply and are not included in the monthly rate.

A modem/router will be required. (You can provide your own equipment or subscribe to managed WiFi Service from Poka Lambro. By subscribing to Poka Lambro Managed WiFi service, I understand and agree to use of the equipment Poka Lambro provides to deliver said service and to pay the monthly fee associated with Managed WiFi. I understand the equipment used to provide the Managed WiFi is the property of Poka Lambro. I understand if the equipment is damaged (with the exception of manufacturer defect) that I will bear all risk of loss, including but not limited to, damages caused by weather or conditions existing at my premises. In the event of disconnection or termination of service, I will return the equipment to Poka Lambro in working order within 10 days, or I will be charged $300.00.)

Do you want Poka Lambro to provide one or do you want to use your own equipment? *

Yes, I want to Subscribe to Managed WiFi for $12.95 per mo.

No, I will provide my own router

If you are subscribing to Poka Lambro Managed WiFi, please indicate the user name you would like the Router here *

If you are subscribing to Poka Lambro Managed WiFi service, please indicate the password you would like used with the router here (password must be 8 characters including one number and one capital letter). *

Do you want a Static IP Address: ($10 per Static IP Address per month) *

No

Yes (Please enter the number of Static IP Addresses you require)) Yes (Please enter the number of Static IP Addresses you require))

Installation * 🛈

Click here to print a copy of the Free Installation contract terms

Terms and Conditions of Internet Service

I agree to abide by the following policies as published on Poka Lambro's website. This incluldes the Acceptable Use Policy, Terms of Service; Network Management Policy; Privacy Policy. Copies will be provided upon request. *

Yes, I agree

No, I do not agree

I understand Poka Lambro offers a 30 day trial period for service. (Click ? for details) * 🛈

Yes

I have read and agree to the terms and conditions for the provision of Internet service and the requirements for FREE installation (Click ? for details) * 🛈

Yes

No

Click here to print a copy of the Free Installation contract terms

TELEPHONE SERVICE

Do you want telephone service? *

Yes, I want phone service

No, I do not want phone service

I want residential telephone service. Click on ? for rates. * 🛈

	Phone Service
Please indicate whether your phone service will be a primary line or second line

I want business telephone service. Click on ? for rates. * 🛈

	Phone Service
Please indicate whether your phone service will be a primary line or second line

Directory Listings (One white pages listing is included, unless you elect non-list. Additional listing is .50 each per month

Non-List Fee ($1.00)

Additional Listing Fee ($.50/each)

List in Directory as:

Additional Listing(s):

Call Blocking Options

	Choose all that you want to apply
Toll Restriction with Toll Free # Access (800#s)	Choose all that you want to apply
Block 900 # Calls (No charge 1st Time)	Choose all that you want to apply
Block 3rd Number Calls (No Charge)	Choose all that you want to apply
Block Collect Calls (No Charge)	Choose all that you want to apply
Block Calling Cards - Outgoing International Calls (No Charge)	Choose all that you want to apply
Block 0+ Calls (No Charge)	Choose all that you want to apply
Block 0+ International Calls (No Charge)	Choose all that you want to apply
Block 1+ Calls (No Charge)	Choose all that you want to apply
Block 1+ International Calls (No Charge)	Choose all that you want to apply

Are you interested in any calling features? *

Yes

No

Would you like to see individual calling feature options or bundled calling feature options? *

Show me individual calling feature options

Show me bundled calling feature options

Optional Calling Features:

Build Your Own Feature Package: Any two features - $5.25; Any four features - $10.25; All twelve features below - $15.65

Build Your Own Feature Package: Any two features - $9.40; Any four features - $15.75; All twelve features below - $22.05

Teen Pack $7.50 (Includes the following: Distinctive Ring, 3-Way Calling, Call Blocker, Speed Dial (8)

Yes

No

Big Saver Bundle 12.50 (Includes the following 7 features: Caller ID Name & Directory Listings Number, Call Waiting, 3 – Way Calling, Call Forwarding Non-List Fee Additional Listing Fee, Speed Dial (8), Repeat Dialing, Anonymous Call Rejection (Res Savings of 7.50)) *

Yes

No

Big Saver Bundle 14.50 (Includes the following 7 features: Caller ID Name & Directory Listings Number, Call Waiting, 3 – Way Calling, Call Forwarding Non-List Fee Additional Listing Fee, Speed Dial (8), Repeat Dialing, Anonymous Call Rejection (Business Savings of 15.00)) *

Yes

No

Build a Multi-Service Bundle - Do you want to bundle your telephone service with another Poka Lambro service? If you elect to Build-a-Bundle, the bundle will include phone service, the Caller ID/Caller ID Call Waiting feature pack, and any other services (long distance, Internet or security monitoring) that you select below. *

Yes, bundle my phone service with the Caller ID bundle and long distance service

Yes, bundle my phone service with the Caller ID bundle and Internet service

No, I don't want to bundle my phone service with any other service

Letter of Agency for Poka Lambro Long Distance Service
Would you like to include Long Distance Calling from Poka Lambro? *

Yes

No

I have selected Poka Lambro as my long distance carrier for both my IntraLATA long distance, my InterLATA long distance. By clicking Yes below, I authorize Poka Lambro to become my long distance carrier and replace my existing long distance carrier (if applicable). Further, this is my authorization for Poka Lambro to act as an agent on my behalf to notify my previous carrier (if applicable) and direct the connection of my long distance services to Poka Lambro. I understand there may be a PIC (preferred Interexchange Carrier) charge from my local phone service provider to make this change. I have read this Letter of Agency, am at least 18 years of age and am authorized to make changes to the long distance service on this account. *

Yes

No

SMART HUB ONLINE BILL PAY AND ACCOUNT MANAGEMENT

SmartHub is Poka Lambro's online bill pay and account management tool. I am interested in signing-up for this free service. *

Yes

No

PREVIOUS OCCUPANT, SPECIAL DIRECTIONS, OR OTHER SITE INFORMATION

Name of previous resident or business at this location

Location: Provide your physical address and directions by including the nearest city, existing highway intersection, and/or landmarks. If your address is in town, please respond with In Town. *

Comments: Provide any information you think Poka Lambro personnel should know about your location (guard dog, locked gate, etc.)

HOW DID YOU HEAR ABOUT POKA LAMBRO?

*

MEMBERSHIP APPLICATION (COOPERATIVE AREAS ONLY)

The undersigned (hereinafter call the Applicant) hereby applies for membership & agrees to take service from Poka Lambro Telephone Cooperative, Inc. (hereinafter called the Cooperative), a non-profit organization existing under the laws of the State of Texas for the purpose of purchasing service, upong the following terms and conditions:

1. The Applicant will pay a membership fee of $50.00 plus installation and other fees.

2. The Applicant wil, when service becomes available, take from the Cooperative telephone service to be used on the premises, described herein, and will pay for such services monthly rates to be determined from time to time in accordance with the by-laws and tariffs of the Cooperative. All payments are due and payable by the dur date on your bill.

3. The Applicant grants the Cooperative a right-of-way easement to construct, operate and maintin the system on the applicant's property.

4. The Applicant will comply with (and be bound by) all provisions of the charter, by-laws of the Cooperative, and the rules and regulations as may from time to time be adopted by the Cooperative.

5. The Applicant, by becoming a member, assumes no personal liability or responsibility for any debt or liabilities of the Cooperative, and it is expressly understood his or her private property is exempt from execution of such debts or liabilities.

6. The Cooperative may, at any time at its sole discretion, revoke the privilege of extending credit to the Applicant for future services.

7. The Applicant authorizes the Cooperative (or it designee) to verify Applicant's creditworthiness by obtaining a credit report, and directly contacting banks, lending institutions, and suppliers in connection to this initial application. An additional deposit may be required to establish credit. The Cooperative is authorized to continue verification of creditworthiness until the account is paid in full or the authorization is revoked in wiriting.

Applicant Electronic Signature

Spouse Electronic Signature

YOUR ACCOUNT INFORMATION

In accordance with federal law, we protect your Customer Proprietary Network Information. These rules require that you establish an Account Password to be used to authenticate your identity when you obtain information regarding your account. (May include letters and number, but should be limited to 30 characters or less. Do not include readily available biographical information, account information, social security numbers, mother's maiden name, address, or date of birth.) *

Challenge Question in the event you forget your password - What is the name of your favorite teacher? *

Please list individuals you want to add as Authorized Representatives on the account:

I acknowledge that unless I request a specific opt-out, Poka Lambro may contact me regarding new services or offers using my CPNI. This information is NOT provided to any outside entities. *

Yes

Verification of Identity and Electronic Signature

Upload a file containing your valid drivers license or other valid legal picture identification. *

Upload articles of incorporation, corporate officer authorization, or other supporting business documents here *

Signature - Please use your cursor to write your signature. (I understand a credit check will be conducted as part of the service application process) *

clear

Tone Dialing (FREE)	Call Waiting ($3.00)	3-Way Calling ($2.00)
Call Forwarding (variable) ($2.00)	Speed Dial (8) ($2.50)	Speed Dial (30) ($3.00)
Priority Ringing ($3.50)	Special Call Acceptance ($2.00)	Preferred Call ($2.00)
Forwarding Call Forward ($2.00)	Busy Repeat Dialing ($2.00)	Anonymous Call Rejection ($2.00)
Call Blocker ($3.50)	Call Return ($4.00)	Call Waiting ID ($3.50)
Call Hold ($1.00)	Caller ID Name Only ($5.95)	Caller ID Number Only ($5.95)
Caller ID Name & Number ($6.50)	Distinctive Ring ($3.50)	Safety Line ($3.00)
Call Trace ($10.00/successful trace)	Terminating Call Manager ($3.00)	Inside Wire Maintenance ($3.95)
Basic Voicemail ($6.95)	Enhanced Voicemail ($8.95)

Tone Dialing (FREE)	Call Waiting ($3.00)	3-Way Calling ($3.50)
Call Forwarding (variable) ($3.00)	Speed Dial (8) ($3.50)	Speed Dial (30) ($4.50)
Priority Ringing ($4.50)	Special Call Acceptance ($3.00)	Preferred Call ($3.00)
Forwarding Call Forward ($3.00)	Busy Repeat Dialing ($4.00)	Anonymous Call Rejection ($3.00)
Call Blocker ($4.50)	Call Return ($5.00)	Call Waiting ID ($4.50)
Call Hold ($1.00)	Caller ID Name Only ($7.50)	Caller ID Number Only ($7.50)
Caller ID Name & Number ($9.50)	Distinctive Ring ($5.00)	Safety Line ($3.00)
Call Trace ($10.00/successful trace)	Terminating Call Manager ($4.00)	Inside Wire Maintenance ($3.95)
Basic Voicemail ($7.95)	Enhanced Voicemail ($9.95)

Julie Bass	Direct Mail
Web Site	Social Media
Newspaper	Billboard
Brochure	Word of Mouth
CSR	Public Event
Phone Book	Newsletter
Bill Message/Insert	Other Other

Call Waiting	3-Way Calling
Call Forwarding (variable)	Speed Dial (8)
Speed Dial (30)	Repeat Dialing
Call Blocker	Call Return
Call Forward Busy	Call Waiting ID
Caller ID Name & Number	Anonymous Call Rejection