Telephone Service Application

Account Information

First Name*

Middle

Last*

Mailing Address

City

State

Zip Code

Physical Address*

City

State

Zip Code

How long have you been at this address?*

Rent or Own

Rent

Own

Former Address

Spouse/Roommate Name

Phone*

Email

Long Distance Carrier

Plan (Interlata: Inside the 606 and 859 area codes)

Thacker-Grigsby Long Distance ($0.12/minute)

Other LD Provider (A TG Rep will contact you)

I do NOT want Long Distance service on my line

Plan (Intralata: Outside the 606 and 859 area codes)

Thacker-Grigsby Long Distance ($0.12/minute)

Other LD Provider (A TG Rep will contact you)

I do NOT want Long Distance service on my line

Custom Features

Select all applicable

Anonymous Call Rejection ($2.00)

Automatic Recall ($2.50)

Call Forwarding ($3.00)

Caller ID on Call Waiting ($1.00)

Caller ID (Number Only) ($5.00)

Distinctive Ringing ($3.00)

Selective Call Rejection ($2.50)

Speed Dialing (30 numbers) ($3.60)

Voicemail ($5.00)

Select all applicable

Automatic Call Back ($2.50)

Busy Call Forwarding ($3.00)

Call Waiting ($3.50)

Caller ID (Name and Number) ($7.00)

Calling Number Delivery Blocking (FREE)

Selective Call Acceptance ($2.50)

Speed Dialing (8 numbers) ($2.30)

Three-Way Calling ($4.25)

Customer's Choice Package ($15.00)

Unlisted Number Option

I do NOT want my number published in the telephone directory. I understand there will be a $10.00 one-time fee and a $1.50 monthly fee for an unlisted number.

Lifeline/Link Up

If you are eligible for the Lifeline/Link Up program, please visit our business office to provide proper proof.

Payment Information

A $50.00 installation fee must be paid in order to process this order.