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

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


Residential Telephone Service Agreement

Phone Number (712) -______________________

Name: ____________________________________
Service Address ____________________________________
Billing Address:: ____________________________________
City: ____________________________________
State: Iowa
Zip: ____________________________________
Social Security #: ____________________________________
Employer: ____________________________________

Previous Telephone #:


Calling Features

__________ Call Waiting $2.00
__________ Caller ID $3.00
__________ 900 Blocking $2.00
__________ Call Forwarding $2.00
__________ 3-way Calling $2.00

Wire Maintenance Plan

__________ Monthly Cost: $1.50   The Wire Maintenance Plan protects you from expenses relating to the inside telephone wiring in your home. If you subscribe to this service, STC will repair or replace any inside wiring that creates a service problem.

900 Number Blocking

__________ Yes, I would like STC to block access to all 900 telephone numbers dialed from this phone line. ( There is no charge for this service.)

PIC Freeze

__________ Yes, I would like STC to enact a "PIC Freeze" on any changes to my long distance carrier. I understand that with the PIC Freeze in place, all requests for long distance carrier changes will be rejected unless notification is received by STC from the customer prior to receipt of such a request. (There is not charge for this service.)

Total Local Services

Schaller Local Telephone Service $__________

*Residential $18.00

*single line access $6.50 + tax

*Business $19.99

*single line access $6.50 + tax

*multi line access $9.20 + tax

Wire Maintenance Plan $__________
Subscriber Line Charge $__________
E911 Surcharge $__________

Buena Vista County $1.00

Crawford County $1.00

Ida County $1.00

Sac County $1.00

Woodbury County $1.00

TOTAL Local Service Charges $__________
*Does not include federal, state and local taxes, or long distance charges that will be added to your monthly bill.

Long Distance

I choose the following company(ies) as my long distance carrier(s):

Name of Inter LATA Carrier: _____________________

CIC Code _____________

Name of Intra LATA Carrier: _____________________

CIC Code _____________
4 Digit code assigned by Carrier  
Toll Restricted 9999 $2.00 charge
ANC 0342 Call 275-4211 to set up account
AT & T 0288 Call 800-222-0300 for residential; 800-222-0400 for business
MCI 0222 Call 800-444-2222 for residential; 800-444-3333 for business
SPRINT 0333 Call 800-877-4500 for residential; 800-877-4020 for business


In making this Application, the undersigned agrees to the rules and regulations of Schaller Telephone Company as set forth in this tariff and Communications Policy, and to the general changes in rules or rates for the service furnished under this Application.
Applicant's Signature: _________________________________
Application Taken By: _________________________________ (emp initials)
Date: ___________/__________/___________

Serving Cushing, Galva, Kiron, Schaller