Membership, Credit and Service Application

Transcription

1 Membership, Credit and Service Application 510 Broadway ~ P.O. Box 136 Abercrombie, ND Call or Fax: Date Membership # Phone # Assigned 1. Billing Name and Address (please print) Name Address City State Zip Code 2. Past Service Information Home telephone # Cell Phone # Previous phone # Have you had service with our company before? Residential Social Security # If yes, when? Business Incorporated Fed. ID# Bus/Res. Not available in all exchanges, must meet specific criteria Date service is to be connected 3. Credit Information Do you rent your home? Yes No If yes, landlord's name Employed by: years Spouse employed by: years Work phone: Applicant Spouse Name & phone # of relative not living with you who knows where you can be reached: Relationship: Phone # 4. Service Location Information Has there ever been telephone service at this location? Yes -- Who lived here last? No -- Provide township, range & section or directions. 911 address County Name of nearest neighbor MEMBER SERVICE AGREEMENT THE UNDERSIGNED hereby applies for membership in the Red River Rural Telephone Association, a Minnesota Cooperative (hereinafter called the Cooperative. ) As a part of this application, the undersigned agrees as follows: (a) To purchase from the Cooperative telephone service as specified in the Bylaws of the Cooperative, and, after obtaining membership, continuing to receive service: and (b) To comply with and be bound by the Articles of Incorporation and Bylaws of the Cooperative, and, any rules and regulations adopted by the Board of Directors. (A copy of the Bylaws can be found in our telephone directory.) Applicant's signature (if signing for a business, please include your title) (To be filled out by the Telephone Company) The above application for membership accepted by resolution this day of, 20 Red River Rural Telephone Association By President of Cooperative

2 BILLING NAME AND ADDRESS INFORMATION The Federal Communications Commission (FCC) has directed all local telephone companies to provide a subscriber s billing name and address (BNA) data to long distance carriers when (1) the subscriber accepts a third party or (2) the subscriber has placed a call using a long distance carrier other than the company to which the caller is presubscribed. The BNA information will only be provided when necessary for the long distance carrier to issue proper billing. The FCC has directed that your Billing Name and Address data can only be used by the long distance carrier for billing purposes. CALLING FEATURES & MONTHLY CHARGES Auto Callback $1.50 Auto Recall $1.50 Call Forwarding Basic $1.00 Call Forwarding - Busy Line $1.50 Call Forwarding - Don t Answer $1.50 Call Forwarding - Fixed $2.00 Call Waiting $1.00 Call Waiting ID (requires Caller ID) $2.00 Caller ID Number Only $3.00 Caller ID Name & Number $4.50 Distinctive Incoming Ring $5.00 Distinctive RNG/CWT $1.50 Inside Wire Maintenance $1.25 Originating Call Management $3.50 Selective Call Acceptance $1.50 Selective Call Forwarding $1.50 Selective Call Rejection $1.50 Speed Dial - 8 numbers $1.00 Speed Dial - 30 numbers $2.00 Telemarketer Call Screening $ Way Calling $1.00 Voice Mail Basic $3.95 Voice Mail Enhanced $4.95 SERVICE RESTRICTIONS Allow 3rd party billing Call charges apply Allow collect calls Call charges apply Caller ID line blocking (residential) No charge International call block No charge 900 numbers block No charge Restrict long distance calls No charge Listed Unlisted Non-published ($1/month) Directory Name Directory Address Additional Listing (25 per month) Customer Owned DIRECTORY EQUIPMENT Leased COMMOM CENTS PROGRAM Red River Communications has a Common Cents program in which customers have their monthly bills rounded up to the nearest whole dollar and the additional amount is pooled in a fund to assist local communities and nonprofit organizations. Funds collected help improve life within our communities. New customers are automatically enrolled in the Common Cents program. Participation is optional and you may change your participation at any time. MARK THE BOX BELOW IF YOU DECIDE NOT TO PARTICIPATE IN THE COMMON CENTS PROGRAM. Remove my account from the Common Cents program. FOR OFFICE USE ONLY ADDITIONAL SERVICES/NOTICES Type of service: Residential Business Business/residential Automatic payment options: Auto bank pay Credit card E-bill CPNI form returned Long distance carrier selected Any interest in the following services: Internet SecureIT Cellular Deposit required? Y / N Amount $ Date paid COMMENTS/NOTES

3 ACCOUNT PRIVACY (CPNI) Form The FCC mandates that all telecommunications companies safe guard Customer Proprietary Network Information (CPNI) data. In general terms, CPNI is personal information stored and collected by Red River Communications for billing and provisioning service. Examples of protected information include call detail, services and features subscribed to and carrier selected. Examples of non-protected information, because it is of public record, include name, address and phone number if published. Red River Communications will do everything possible to protect the privacy of your CPNI information. Part of the rule changes by the FCC requires Red River Communications to perform a customer authentication process anytime you call for protected information about your account or if you come into the office. The following procedures have been put into place by Red River Communications to comply with these requirements. If you come to the office for information, please bring a copy of your complete bill with you. If you do not have your bill you will need to provide a valid photo ID before we can share information on your account. If you are calling the office, you need to provide your CPNI password to allow us to share information about your account. Please create a CPNI password that you would like to use. Security questions may be set up on your account in the event you call our office to inquire about your account and do not remember your password. Answering these security questions will allow you to access your account. Please fill out at least one of the security questions and answers below. Additional Authorized Contacts: In addition, information will only be given to the name of the person on the account. If you would like other people (husband, wife, family, etc) to have access and/or make changes, please provide the names below of those whom you wish to have access to your account. Remember, all contacts will need to know the password and security questions when they call in to our office. Thank you for assisting us in protection your information. If you have any questions, please call our business office at or Account Holder Name: Typed or Printed Signature Password: Phone #: Please provide a simple question(s) and answer(s) for the times you need to contact Red River Communications. Common information such as mother s maiden name, birthday, home address or social security number should NOT be used as a password. Question 1: Pets name(s)? Answer: Question 2: Favorite color? Answer: Question 3: Answer: (Create your own question) Please identify any additional authorized contacts: Additional Authorized Contact: Additional Authorized Contact:

4 LONG DISTANCE CARRIER SELECTION & FREEZE FORM Please complete and return this form to Red River Communications. Subscriber's Name Requested by Phone # CARRIER SELECTION: Long distance service is divided into two calling areas called intralata and interlata. Long distance companies may choose to serve one or both LATAS. This map is also shown in the front section of the telephone directory. See the attached list of available carriers. The Fargo/Brainerd area in white is your intralata calling area. Everywhere outside the white area is your interlata calling area. interlata: change from present carrier to new carrier (name of carrier) (name of carrier) Carrier's 4-digit ID code (shown on long distance carrier list): intralata: change from present carrier to new carrier (name of carrier) (name of carrier) Carrier's 4-digit ID code (shown on long distance carrier list): To ensure proper billing, please contact carriers when selecting or disconnecting their services. FREEZE REQUEST (optional) To avoid being "slammed," meaning your long distance carrier(s) is changed without your permission, you can "freeze" your long distance carrier(s). Then NO carrier change can be made UNLESS you contact your local telephone company. A "FREEZE" IS FREE. Mark below to "freeze" your carrier(s). Also, contact your local telephone company to remove a freeze. Freeze my carrier(s) for both LATAs. OR Freeze just my intralata carrier. Freeze just my interlata carrier. Signature Date

5

6

7 Red River Long Distance Forms If you want to change to Red River Long Distance, please complete this form and return it to Red River Communications - P.O. Box Abercrombie, ND Name Just 12 a minute Day or Night Anywhere in the USA. Automatic volume discounts apply when RRLD charges are: $0 to $19.99 = 12 min. $20 to $39.99 = min. $40 to $79.99 = 11.3 min. $80 to $ = 10.6 min. $200 or more = 9.2 min. Each call is billed in 6-second increments with a 30-second percall minimum. For more information call toll-free or Signature Phone # LATA Selection - Long distance service is divided into two calling areas intralata, (calls within a LATA or area) and interlata (calls between LATAS or area). Carriers may serve one or both LATAS. For a map of the LATAS calling area, see page 22 in our telephone directory. Please change and freeze my InterLata carrier to Red River Long Distance (please check) Please change and freeze my IntraLata carrier to Red River Long Distance (please check) To ensure proper billing, please contact carriers when selecting or disconnecting their service. If you already have Red River Long Distance service, simply call our office to select one of the plans below. Call 60 Minute Plan (60 minutes for $5.95/month) Billed in full minutes. Overage is 12 /min. Call 200 Minute Plan (200 minutes for $15.95/month) Billed in full minutes. Overage is 10 /min. Call 350 Minute Plan (350 minutes for $24.95/month) Billed in full minutes. Overage is 9 /min. Call 600 Minute Plan (600 minutes for $39.95/month) Billed in full minutes. Overage is 8.5 /min. Call 1000 Minute Plan (1000 minutes for $59.95/month) Billed in full minutes. Overage is 8 /min. Red River Long Distance Savings Plans To switch to Red River Long Distance, complete and return this form to Red River Communications - P.O. Box Abercrombie, ND Please sign me up for the - (select one) Call 60 Minute Plan (60 minutes for $5.95/month) Call 200 Minute Plan (200 minutes for $15.95/month) Call 350 Minute Plan (350 minutes for $24.95/month) Call 600 Minute Plan (600 minutes for $39.95/month) Call 1000 Minute Plan (1000 minutes for $59.95/month) Direct dial calls within the United States. Each call is rounded up to a full minute. Name Phone # Signature _ Call or toll-free. * Red River Long Distance savings plan rates apply to all (intralata and interlata) long distance calls.

8 Automatically pay your monthly bill! Auto Bank or Credit Card Pay Authorization Form AUTHORIZATION FORM FOR AUTOMATIC PAYMENT I authorize Red River Communications and the financial institution named below to initiate entries to my checking account or credit card. This authorization will remain in effect until I notify the company in writing to cancel it. Red River Communications will have a reasonable opportunity to act on it. I can stop payment by notifying my bank 3 days before my account is charged. I can have the amount of an erroneous charge immediately credited to my account up to 15 days following issuance of my bank statement or 60 days after posting, whichever occurs first. (Company) (Billing Name - please print) (as it appears on bill) (Telephone Number) (Address) (City, State, Zip Code) (Signature) (Date) Monthly Credit Card Payment or Auto Bank Pay (Deduction from credit card or auto bank occurs on 6th to 8th each month) Credit Card Number Please send a voided check Billing name as it appears on Credit Card (Please Print) Credit Card Number Billing name as it appears on Credit Card (Please Print) Credit Card Number Billing name as it appears on Credit Card (Please Print) Credit Card CVV/CVC (Last three digits on signature line on back of card) Expiration Date Month Year (Financial Institution Name) (Financial Institution Address) (City, State, Zip Code) _ (Bank Transit Number) _ (Checking Account Number) If you have any questions please call Red River Communications at or toll-free. Please mail to: Red River Communications PO Box 136 Abercrombie, ND 58001