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Application for Business Land Line Service

*Full Business Name:
*Service Address Type of Business:
*Billing Address: Duration of Business:
Is your lot: | || | ||
If your lot is a double lot, please select one:
More than one building in your lot? , if Yes please state:
Has the business or any other related entity had telephone service before? |
If Yes, please state: ,
Nearest telephone service. ,
Toll Limit:    
Bank Reference: Credit Reference:
Type of Service Required Premises had previous service:
|
Touch Tone: Rotary Dial: Bold Listing:
Call Waiting: Non Published: PABS/KEY System/Lines:  
3 Way Call: Additional Listing: FAX:
Other Service/Facility/Equipment
Call Forwarding: Speed Dialing: TELEX:
I.D.D.D: Leased Line: Yellow Page Listing:
*Contact Name Terms & Conditions:
Please click here to read terms and conditions.
*Contact Telephone: *I agree to the terms and conditions:
*Contact E-mail: | *[required fields]