Schaller Telephone Company
111 West Second Street
PO Box 9
Schaller, Iowa 51053

Office: (712) 275-4211
FAX: (712) 275-4121

Internet Service Agreement

 

Name: ____________________________________
Address ____________________________________
City: ____________________________________
State: Iowa
Zip: ____________________________________
Daytime Telephone ____________________________________
Fax Telephone: ____________________________________

Billing Address
(if different)

____________________________________
   
Preferred Username
(e-mail address):
____________________________________
  (8Characters Max.)                     
Mother's Maiden Name ____________________________________
  (Needed for password Security)

Package:  System type: (Choose one)
[ ]  Local calling area access   $ 26.95/month  Win 95 ____________________  
  Win 98 ____________________
(NOTE: up to 4 email address is included with account) MAC ______________________
  iMAC _____________________
[ ] Additional email address $10.00/month each WebTV ____________________
[ ] DSL 512K $39.99/month Internet TV _________________
[ ] DSL 1Mb $49.99/month Win ME ___________________
  Win XP ___________________
  Win 2000 ____________________
   
1st additional email address username _________________ REAL name__________
2nd additional email address username _________________ REAL name__________
   

Prices & Availability subject to change without notice.
800 number access available through netINS.

Customer Signature__________________________________ Date ____/______/______   
   
Please return this completed form to:   

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

   
   

Authorized Telco Signature______________________________

Active date  ______/______/__

 

Serving Cushing, Galva, Kiron, Schaller