Schaller Telephone Company
111 West Second Street
P.O. Box 9
Schaller, Iowa 51053

Toll Free: (800)-469-9099
Phone: (712)-275-4211
Fax: (712)-275-4121


Schaller Telephone Company Request for Service

New Customer or Current Customer Service Address
MOVE
COMP: #032
Name: ____________________________________ Date: ______________
Address _________________________Apt. #______ PO Box: ____________
City: ____________________________________ Zip Code:___________
State: Iowa
Home Phone: _________________________Work Phone.____________________
Contact: ____________________________________

Billing Address: (If Different)

Name: ________________________________________________________
Address ________________________________________________________
City: _________________________State: __________Zip Code:________

Service Information
1. Type of Service
BASIC HBO MAX STARZ/ENCORE
Installation Fee $45.00 plus tax

2. Has there been cable in the house before? Yes _______ No _______

If there is more than one outlet, which one do they want to be hooked up to?

_____________________________________________________________

A. If yes - It's a Reconnect - No one will need to be there
B. Unless there has been Satellite there before then someone has to be there
C. If no - It's a NEW INSTALLATION - Someone will need to be there
D. Who lived there before? ____________________________________



3. Do you rent or own your home or apartment? _______________________

A. Renters need their Landlord's Consent before we can do a new install.
B. Landlord's Name and Phone Number? __________________________



4. Do you need any additional outlets installed? Yes _______ No _______
Cost to the customer: at the time of the install it is $15.00 per outlet



Disconnect service
Date of Disconnect: _________________________________
Forward Address of customer:
__________________________________________________________________

__________________________________________________________________