New Service / Reconnect Service /
Add Phone Line

(Failure to complete ALL sections completely could delay the processing of your order)


*  Required

New Account Information:

New Service Address:
(Physical Location - No Post Office #'s)
Name:
Address:
City:County:
State:Zip:
Inside City Limits?YesNo



Billing Address:
(If different from Service Address)
Name:
Address
City:
State:Zip:



Date of Birth:

I grant Public Service Telephone Company permission to enter and cross said property for the purpose of installing and, if necessary, repairing telephone service.

How many people live in this residence?Please List Names:

Directory Listing:
(If different from Service Address)
Name:      
Address:  



Other Account Information Required:

Exchange (City):
   
Type of Service: Residential         Business

Requested Date to Begin Service:
Daytime Contact #:
Fax #:
Employer:
Employer's Phone:
E-Mail Address:
Has applicant had previous telephone service with any company?  YES     NO
If yes:
Give previous company name:
And previous company telephone number: