Telecommunications Service Application


Name(s) (First, Middle Initial, Last)
Extra Directory Listing($.50/month)
Directory Address
Box
Apt No.
County
City
State
Zip +4
Billing Address (if different)

Have you had service with Ntec/Nelson Telephone/Chippewa Valley Cable
Yes No
Capital Credit Number

Non Pub ($1.00 Mth)
Yes No
Non List ($1.00 Mth)
Yes No
(Safeguard your number from Caller ID: dial *67 each time you dial out)

Own Rent
You will need to provide a copy of your rental lease or title to home. Only persons listed on the lease or title are allowed to be listed as owner on your Ntec account

Long Distance
Local Call Access Only (additional $1.50/month plus monthly charges)
*NtecLD (Ntec Long Distance $.12 a minute)
AT&T
MCI
Sprint

You Must Choose a Long Distance Carrier Or You Won’t Be Able To Place a 1+ Long Distance Call. Ntec only bills for Ntec Long Distance. You must contact your Long Distance provider to set up an account before placing long distance calls.


Bundle (Phone, Internet, TV)
Phone, Internet

    User Name

****Please answer the Following Questions****

You will need to use this password or know the answer to one back-up question when calling in to discuss your account or make any changes to your account

Authorized User(s) to request info or make changes to your account

Account Access Password

Answer two of the following back-up questions

What is your favorite holiday?

What is your favorite vacation location?

What is your mother’s maiden name?

What town were you born in?



Preferred E-Mail address

Cell Phone Number


Would you like information on paperless billing or auto bank collect? Yes No


The undersigned, hereinafter called the “Applicant”, hereby applies for telephone service with Nelson Communications Cooperative, a corporation duly organized and existing under and by virtue of the laws of the State of Wisconsin, hereinafter called the “Cooperative”, for the purpose of having furnished to said “Applicant” telephone services upon the following terms and conditions: The “Applicant” will take from the “Cooperative” telephone services when available and will pay monthly rentals to the “Cooperative” in accordance with the rate schedules and rules and regulations established by the “Cooperative” in accordance with the directives of the United States of America and the State of Wisconsin and their regulatory bodies. The “Applicant” hereby grants to the “Cooperative”, a right-of-way easement to construct, operate and maintain a telephone line or system on its or his premises and in or upon all streets, roads or highways abutting said premises, and also such service lines are necessary, and also the right to cut or trim trees and to bury cable necessary to the efficient operation of said system. The “applicant” will comply with and be bound by the provisions of the bylaws, rules and regulations of this Association and such amendments as may from time to time be adopted.

AGREE TO TERMS


Signature (Type in First, Middle Initial and Last)



Date