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SERVICE APPLICATION
Telephone # (if known):
Member # (if known):
Billing Name & Address:
Directory Listing:
Name:
Mailing Address:
Addl Listing:
Physical Address:
Non-List:Non-Pub:
City: State: Zip:
Contact Phone Number:
Email Address:
Applicant SS#:
Employer:
Co-Applicant SS#:
Previous # at location (if known):
Previous Occupant:
Comments: (Location Description)
Choose Following Services:
Long Distance Carrier:
ATT Calling Plan:
Date Notified:
Touchtone
Rotary
Call Waiting
3 Way Calling
Call Forwarding
Short Speed Call
Long Speed Call
Caller ID
VoiceMail
900 Block
Internet Basic Net Plus DSL
P.O. Box 205Wisdom, MT 59761Telephone: 406-689-3333 or 888-263-2270 Fax: 406-689-3959Email: smtc@smtel.com