NAME OF APPLICANT: EMPLOYED: SECURITY PASSWORD: AUTHORIZED INDIVIDUAL: SS#: 911 ADDRESS: MAILING ADDRESS: CONTACT NUMBERS:

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1 PLANTERS TELEPHONE COOPERATIVE / FAX: P O BOX 8 (100 OGEECHEE ST) NEWINGTON, GA Website: / Address: planters@planters.net NAME OF APPLICANT: DATE: SS#: BIRTHDATE: EMPLOYED: SECURITY PASSWORD: AUTHORIZED INDIVIDUAL: SS#: 911 ADDRESS: MAILING ADDRESS: CONTACT NUMBERS: * WE ARE UNABLE TO CHECK CREDIT WITH YOUR PREVIOUS TELEPHONE COMPANY, THEREFORE WE WILL HAVE TO PULL A CREDIT REPORT. NEW MEMBER: YES: NO: *IF YOU ARE A NEW MEMBER, A $10 NON-REFUNDABLE MEMBERSHIP FEE IS REQUIRED. SERVICE REQUESTED: RESIDENCE: BUSINESS: DUE DATE: GIVE A BRIEF DESCRIPTION OF THE HOME (ex: COLOR) HAS THERE BEEN TELEPHONE SERVICE AT THIS LOCATION BEFORE? YES NO IF YES, WHO WAS THE LAST OCCUPANT WITH TELEPHONE SERVICE: TELEPHONE NUMBER: DISCONNECT DATE: IF IN A SUBDIVISION, GIVE NAME OF SUBDIVISION AND LOT NUMBER: IS YOUR HOME WIRED FOR JACKS? YES NO HOW MANY DO YOU NEED INSTALLED? DO YOU REQUEST FOR PLANTERS TO MAINTAIN THE INSIDE WIRING? YES NO *IF PLANTERS MAINTAINS THE WIRING, THERE WILL BE A MONTHLY CHARGE OF $1.50 FOR RES & $3.00 FOR A BUS. DO YOU NEED TO LEASE A PHONE FROM OUR OFFICE? YES NO ($2.75 MONTHLY FOR EACH PHONE) I WISH FOR MY TELEPHONE NUMBER TO BE: PUBLISH / NONPUB ($0.50 MONTHLY CHARGE) LIST AS: ADDED LISTING: TOTAL BLOCK TOTAL BLOCK WITH PIN TOTAL BLOCK W/800 ACCESS COLLECT 3 RD # 011(OVERSEAS) 900# PLEASE ESTIMATE THE AMOUNT OF LONG DISTANCE CALLS PER MONTH : $0-5 $5-10 $10-20 $20-30 $30-40 $40-50 OTHER PLANTERS LONG DISTANCE CALLING PLANS: (BASIC IS.10 PER MINUTE & NO MONTHLY CHARGE) 200 MINUTES - $ MINUTES - $ MINUTES - $ MINUTES-$100 (AFTER MINUTES ARE USED IT WILL BE.10 PER MINUTE) FOR OFFICE USE: NUMBER ASSIGNED: SERVICE ORDER NUMBER ALL THE BELOW SERVICES ARE CHARGED MONTHLY

2 BASIC SERVICE: $3.00 ENHANCED SERVICE: $4.00 HOLDS UP TO 10 MESSAGES, OF UP TO TWO MINUTES EACH. MESSAGES CAN BE KEPT FOR SEVEN DAYS. THIS IS USUALLY FOR A SINGLE PERSON OR SMALL FAMILY. THIS IS THE SAME AS BASIC SERVICE AND IT FEATURES MAILBOX TO MAILBOX CAPABILITY. DELUXE SERVICE: $5.00 PREMIUM SERVICE: $7.00 HOLDS UP TO 20 MESSAGES, OF UP TO TWO MINUTES EACH. HOLDS UP TO 40 MESSAGES, OF UP TO TWO MESSAGES CAN BE KEPT FOR 14 DAYS AND IT FEATURES MAILBOX TO MAILBOX CAPABILITY. THIS IS USUALLY FOR A SMALL TO MEDIUM-SIZED BUSINESS. GREETING PLUS: $2.00 THIS IS FOR OUTGOING GREETINGS ONLY AND NO INCOMING MESSAGES. THIS GREETING CAN LAST UP TO THREE MINUTES. MINUTES EACH. MESSAGES CAN BE KEPT FOR 14 DAYS AND IT FEATURES MAILBOX TO MAILBOX CAPABILITY. THIS IS BETTER FOR LARGE BUSINESSES OR TRAVELERS. CUSTOM CALLING SERVICES TOLL CONTROL WITH PIN (TOTAL BLOCK REQUIRED) $3.00 CALL WAITING $1.50 THREE-WAY CONFERENCE CALLING $2.50 CALL FORWARDING $1.50 CALL RETURN (*69) $3.00 CALLER ID (DISPLAYS NUMBER ONLY) $5.00 CALLER ID WITH NAME & NUMBER DELIVERY $6.50 CALL WAITING DELUXE (COMPATIBLE WITH CALLER ID) $3.50 UNIDENTIFIED CALL REJECTION FOR CALLER ID $3.50 CALL FORWARD BUSY LINE (NOT COMPATIBLE WITH VM) $2.50 SPEED CALLING (8 LIST) $1.50 SPEED CALLING (30 LIST) $3.00 WAKE UP SERVICE $2.00 DO NOT DISTURB $2.00 AUTOMATIC CALL BACK $3.00 DISTINCTIVE RINGING $3.00 SELECTIVE CALL FORWARDING $3.00 SELECTIVE PRIORITY CALL $3.00 CALL SCREENING $3.00 ADDITIONAL PERSONAL RINGING ONE ADDITIONAL NUMBER $2.00 TWO ADDITIONAL NUMBERS $3.75 DSL SERVICE: A = B = $49.95 PLUS TELEPHONE SERVICE (PLANTERS DOES NOT OFFER W/O) * $5 MORE WITHOUT PLANTERS LONG DISTANCE & 2 CALLING FEATURES ** STATIC IP - $10 MORE *$ SET UP FEE WAIVED WITH 6 MONTHS SERVICE PURCHASE A DSL MODEM FOR $150 LEASE A DSL MODEM FOR $7.95 PER MONTH (CAN BE BILLED IN 3 MOS - $50 EACH MONTH) (LEASE FOR 19 MONTHS) SEE WEB SITE ( FOR DSL SPEEDS & COMPATIBLE MODEMS PLANTERS TELEPHONE COOPERATIVE EQUAL ACCESS BALLOT ACTION REQUIRED

3 SELECT A CARRIER FOR YOUR INTRA & INTER LATA CALLING INTRA LATA CALLING CARRIERS INTER LATA CALLING CARRIERS ( ) ALLNET / GLOBAL CROSSING ( ) ALLNET / GLOBAL CROSSING ( ) AT&T ( ) AT&T Res: Res: Bus: Bus: ( ) MCI ( ) MCI Bus: Bus: Res: Res: ( ) WORLDCOM ( ) WORLDCOM ( ) SPRINT DIAL 1 SERVICE ( ) SPRINT DIAL 1 SERVICE Bus: Bus: Res: Res: ( ) DELTA COMM ( ) DELTA COMM ( ) PLANTERS LONG DISTANCE ( ) PLANTERS LONG DISTANCE ( ) BELL SOUTH (IntraLata Only) ( ) NO LONG DISTANCE CARRIER SIGNATURE DATE *THE ORDER IN WHICH THE COMPANIES ARE LISTED DOES NOT INDICATE A PREFERENCE OR A RECOMMENDATION

4 PLANTERS RURAL TELEPHONE COOPERATIVE TELEPHONE/DSL/BROADBAND PACKAGES RESIDENCE CUSTOMERS ONLY DSL 11 PACKAGE INCLUDES: MONTHLY LOCAL TELEPHONE SERVICE CALLER ID CALL WAITING 3 WAY CALLING SPEED DIAL CALL FORWARDING CALL RETURN 10 MINUTES OF LONG DISTANCE DSL/BROADBAND Up to 4.0 Meg Down DSL 12 PACKAGE INCLUDES MONTHLY LOCAL TELEPONE SERVIICE CALLER ID CALL WAITING 3 WAY CALLING SPEED DIAL CALL FORWARDING CALL RETURN 10 MINUTES OF LONG DISTANCE DSL/BROADBAND UP to 15 Meg Down 73.95

5 ADDRESS PASSWORD USERNAME PASSWORD For Office Use PASSWORD COLOR OF FIRST CAR DOG S NAME FAVORITE COLOR HIGH SCHOOL FAVORITE FOOD