Change in Service Application Choctaw Telephone Company

Date:                               Date of Change:                                 Phone Number:                                            

Customer Name:                                                      Address:                                                                             

   

What changes do you want:                                                                                                                                 

Decription of charges:

Changing to or from MCA Service (Your telephone number WILL CHANGE): $17.50

Changing number to Non Pub:           $5.00 plus $1.00 per month

Changing your telephone number:      $5.00

Changing Directory Name:                 $5.00

Adding an Add List Name:                $5.00 plus .40 per month

Changing Long Distance Carriers:     $5.00 per lata (No charge if changing to MoKan Communications)

Installing Call Trace:                         $5.00 plus $5.00 per month

Install Number Referral:                    $5.00 plus $5.00 per month

Add Repair Service Plus:                  N/C plus $1:25 per month

Move Demarcation Point:                             $17.50

Combo Line:                                                    Install $17.50 plus $9.90 per month plus .45 per 1/8 of a mile

All Calling Options have an Install Charge of $5.00 for the 1^st and $1.00 for each additional option.

There is no Charge to remove on Option.

Option 1 per month charge:    1 feature $2.00      2 features $3.75     3 features $4.50      4 features $5.00

Option 2 per month charge:     $3.50 each

Option 3 per month charge:     $5.00 each

Customer Signature:                                                                   Order taken by: