Cash Deposit $ Connection Fees $ Monthly. Download Speed. Cost 3M $ M $ M $49.95 Higher speeds available in certain areas.

Transcription

1 Northeast Missouri Rural Telephone Company 718 South West Street, PO Box 98, Green City, MO Application for Membership Customer/Business Name: Social Security #/Federal ID #: Spouse Name: (If joint membership is wanted, both husband & wife must sign application) Spouse Social Security #: Address: Billing Address: Names of other household members (including children): If Business, check one: Individual/Sole Proprietor Corporation Partnership Other Cell or work # where you can be reached: How would you like your name listed in the telephone directory... Listed (print how you would like your name in directory) Extra Listing (45 /month) Unlisted ($1.60/month) (If choosing unlisted, your number will still show on caller ID. Use *67 to block your number every dial.) Do you wish to have any of the following services? (monthly charges may apply) Custom Calling Features Call Waiting Call Waiting on Caller ID Call Forwarding 3 Way Calling Speed Call 30 Distinctive Ringing $1.00 Ring Again $1.00 Warm Line (# ) $1.00 nemrtv Packages Local Vu $22.99 Select Vu $69.99 Choice Vu $ Ultimate Vu $ How many settop boxes do you want installed? $5.95/month/settop Cash Deposit $ Connection Fees $ Total $ High Speed Internet Download Speed Have you had service with us before? Yes (previous # ) No 3M $ M $ M $49.95 Higher speeds available in certain areas. Other Services Pin Number Dialing $2.00 Caller ID Selective Distinctive Ringing $1.50 Selective Call Acceptance $1.50 Selective Call Forwarding $1.50 Selective Call Rejection $1.50 Selective Call Waiting $1.50 Automatic Callback $1.50 Automatic Recall $1.50 Anonymous Call Rejection $1.50 Voice Mail $ Block International Block Inside Wire Maintenance $1.00 Telephone Maintenance $1.00 If you have an address, list here: By signing this application, I certify that I am 18 years of age & have read the Membership Agreement on the back of this form. (If joint membership is wanted, both husband & wife must sign application.) Applicant s Signature : Spouse s Signature: : Note: This application is subject to a credit check. Telephone Number Assigned:

2 MEMBERSHIP AGREEMENT The Applicant hereby applies for membership in and agrees to take telephone service from a corporation organized under the laws of the State of Missouri by the name of Northeast Missouri Rural Telephone Company (hereinafter called the Corporation ) for the purpose of furnishing telephone service upon the following terms and conditions. 1. The Applicant will automatically be a member when they purchase service from Northeast Missouri Rural Telephone Company and live within the 14 exchanges as set forth in the By-Laws. 2. The applicant will take from the Corporation telephone service to be used on their premises, and will pay therefore monthly rates to be determined from time to time in accordance with the By-laws of the Corporation, it being expressly understood that amounts paid for telephone service by the Member in excess of cost of service of the Corporation are furnished by members as capital, and each Member shall be credited with capital so furnished as provided in the By-laws. A membership can be transferred by a member from one property to another within any area served by the Corporation. 3. The Applicant, if owner of the premises, will grant to the Corporation a right-of-way easement to construct, operate and maintain a telephone line or system on the lands described herein and in or upon all streets, roads or highway abutting said land and, if tenant, applicant will obtain any required right-of-way easement from the landlord. 4. The Applicant, by becoming a member, assumes no personal liability or responsibility for any of the debts or liabilities of the Corporation, and it is expressly understood that private property is exempt from execution for any such debts and liabilities. 5. The Applicant understands and agrees that should the Corporation find it necessary to construct additional lines before the customer can receive service after the original contract is completed, or should it become necessary to make an installation charge, that such charges will be made in compliance with the Tariffs, filed with the Missouri Public Service Commission. 6. The Member agrees to comply with and be bound by the Articles of Incorporation and By-laws of the corporation and any rules and regulations adopted by the Board of Directors. The acceptance of this application by the Corporation shall constitute an agreement between the Applicant and the Corporation and shall continue in force until cancelled by notice given by either party to the other. MAINTENANCE AGREEMENTS The inside portion of your wiring is now deregulated, and the Federal Communication Commission and the Missouri Public Service Commission of Missouri gave you, the subscriber, the ownership of that inside portion of the wiring. The part affected is the small wire that hooks inside the lightning arrestor on the outside of your house/building and runs to and includes the jack or connecting block on the inside of the house/building. Northeast Missouri Rural Telephone Company offers to maintain the inside wiring for a monthly charge of $1.00 per month, or the subscriber may wish to maintain it or may wish to hire someone else. The Public Service Commission previously ordered that the ownership of all telephone sets on single line subscribers be transferred to the subscriber. This means ALL equipment used in connection with single-line service such as telephones, extension bells, recorders, programmable sets and hard-of-hearing devices will be owned or leased by the subscriber. Along with this ownership is the responsibility of installation, removal and maintenance. Northeast Missouri Rural Telephone Company will continue to install telephones for anyone who cannot or does not want to do it themselves on a cost plus basis. Northeast Missouri Rural Telephone Company has decided to offer maintenance agreements to those who do not wish to be responsible for the maintenance on their phones. The maintenance plan is priced at $1.00 per month per residence or business establishment. The agreement will be good on all telephones you own within your establishment, except programmable sets, recorders and some of the cheaper throw-away telephone sets or novelty sets obtained from sources other than a telephone company. Northeast Missouri Rural Telephone Company or the subscriber may cancel this agreement at any time upon notice to the other. If the Telephone Company decides to change rates or coverage for the services described in this agreement, a notice will be issued to the subscriber 30 days in advance of the changes. DISCLOSURE UNDER FCC RULE (b) Your local exchange and long distance service cannot be disconnected or interrupted as a result of your failure to pay charges for interstate pay-per-call service, charges for interstate information services provided pursuant to a presubscription or comparable arrangement, or charges you have disputed for interstate tariffed collect information services. You can obtain blocking or access to services offered on the 900 services access code where it is technically feasible, at no charge and on a one-time basis within 60 days after you subscribe to a new number and it becomes effective. Other requests for blocking and requests for unblocking will be subject to a reasonable one-time fee. Our tariffs include the terms and conditions that apply. You have a right not to be billed for pay-per-call services not offered in compliance with Federal laws and regulations established under Titles II and III of the Telephone Disclosure and Dispute Resolution Act. Your access to 900 services may be involuntarily blocked for failure to pay legitimate pay-per-call charges.

3 CPNI NOTIFICATION Under federal law, you have the right to confidentiality of information regarding your telephone services and Northeast Missouri Rural Telephone Company has the duty to protect that confidentiality. This confidential information includes such things as specific services you purchase, the number of services purchased, who your provider is for a service, long distance call detail records, and charges related to the services purchased. This information is referred to as Customer Proprietary Network Information (CPNI). Among the new rules is the option for you to establish a PASSWORD with Northeast Missouri Rural Telephone Company and provide that password during a telephone call from you before we are authorized to disclose or discuss call detail records. For your protection, this password cannot derive from readily available biographical information such as your social security number, mother s maiden name, home address or date of birth. If your account is listed only in your name, you probably should consider assigning one or more Authorized Account Representatives for example, husband, wife, child, parent, roommate, etc. The Authorized Account Representative/s will not be added to your account, but they will be added to our records as being a person/s that you have authorized to make changes to your services or to discuss billing or service information regarding your account. For our married residential subscribers, we suggest for your convenience that both husband and wife be listed as Authorized Account Representatives. If you choose not to establish a password, there are alternatives that can be used in order for us to discuss or provide you call detail information. These methods may prove to be inconvenient for those who call about their account from work, from cell phones, or from any place away from the telephone number of record. Northeast Missouri Rural Telephone Company can send the call detail information to the address of record. We can call you back at the telephone number of record from which your service is derived. We may disclose call detail CPNI to you at our business office with a valid photo ID matching the name listed on the account. We may discuss only the call detail information you provide such as called number, when it was called, the duration of the call, and, if applicable the amount charged for the call. CPNI Notification PASSWORD AND AUTHORIZATIONS Password (password should be between 4 and 10 letters or numbers) List all your telephone numbers Authorized Signature LIST ALL PERSONS YOU AUTHORIZE TO MAKE CHANGES OR DISCUSS INFORMATION REGARDING YOUR ACCOUNT: Note: These are the ONLY persons that we will talk to about your account. For example, you might want to list your spouse, girlfriend/boyfriend, son, daughter, roommate, mother, father, etc. Use for contact? Y or N address: Authorized User Relationship Contact Number OPT-OUT Unless you check the Opt-Out box below, it will be assumed that Northeast Missouri Rural Telephone Company has your approval to offer you products and services that you may find to be valuable additions to your existing services. I want to OPT-OUT. box to left.

4 PIC ZE NOTICE In order to comply with the Missouri Public Service Commission s Chapter 33 requirements, I am notifying Northeast Missouri Rural Telephone Company in writing of my desire to have a PIC freeze added to my telephone service. This authorizes Northeast Missouri Rural Telephone Company to place a PIC freeze on my telephone number(s) I have listed below. I understand that I will be unable to make a change in my long distance service unless I either lift the PIC freeze or unless I personally notify Northeast Missouri Rural Telephone Company of my intent to change my long distance service. I understand that this PIC freeze helps to protect me from my long distance service being changed without my permission. The request to remove the PIC freeze must be either in writing or by a telephone call placed from my telephone service. I understand that this is a free service. Name Address Box, Street or RR City State Zip Code Please add a PIC freeze to my telephone service(s) at: The PIC freeze is to be applied to the following services: Both Interstate and Intrastate Long Distance Intrastate Long Distance Interstate Long Distance SIGNATURE

5 AUTHORIZATION FOR AUTOMATIC PAYMENT Name of Bank: Address of Bank: Bank telephone no. Bank s transit/routing number: Customer bank account no. ing Account Savings Account Customer name & address: Customer telephone no.: (660) This is to authorize Northeast Missouri Rural Telephone Co. to bank deduct my monthly telephone bill on the 10th of each month according to the information provided above. Customer Signature AUTHORIZATION FOR AUTOMATIC CREDIT CARD PAYMENT Visa Discover Mastercard Card number: Card expiration date: CVV2 code (on back of card): _ Card user name & address: Customer telephone no.: (660) This is to authorize Northeast Missouri Rural Telephone Co. to deduct my monthly telephone bill from the above credit card on the 10th of each month according to the information provided above. Customer Signature **Note: There is a $20.00 charge for a denied credit card payment.