Farmers' Telephone Company
404 4th Street
Batavia, IA 52533

Tel: 641-662-2373

NAME_______________________________ SS#__________________________________

911 ADDRESS______________________ CITY________________ STATE_______ ZIP__________

BILLING ADDRESS ( IF DIFFERENT FROM ABOVE)________________________________

NAME OF OTHER ADULTS LIVING AT THIS ADDRESS _________________________________

WHERE TO CONTACT YOU IN CASE OF EMERGENCY #________________________________

TOLL CARRIERS. PLEASE DESIGNATE YOUR CHOICE.
FTC MIN
FTC 100 STATE $5.00 ________ OUT OF STATE $7.00________
FTC 250 STATE $12.50_______ OUT OF STATE $17.50________
FTC 500 STATE $25.00_______ OUT OF STATE $35.00________
FTC 750 STATE $37.50_______ OUT OF STATE $52.50________
FTC 1000 STATE $50.00_______ OUT OF STATE $70.00________
FTC 1250 STATE $62.50_______ OUT OF STATE $87.50________
FTC 1500 STATE $75.00_______ OUT OF STATE $105.00_______
FTC 1750 STATE $87.50_______ OUT OF STATE $122.50_______
FTC 2000 STATE $100.00______ OUT OF STATE $140.00_______
ANYTHING AFTER THE PACKAGE MINUTES WILL BE $.10/MINUTE.

CALLING FEATURES
AUTOMATIC CALL BACK______ AUTOMATIC RECALL____
ANONYMOUS CALL REJECTION____ CALLING NAME AND NUMBER_____
SELECTIVE CALL ACCEPTANCE____ SELECTIVE CALL REJECTION_____
CALL WAITING ID_____ TELEMARKETING SCREENING_____

DEPOSIT FOR LOCAL SERVICE IS $40.00 AND FOR LONG DISTANCE IS $125.00.
DEPOSIT IS DETERMINED BY A CREDIT CHECK OR BY YOU GETTING A CREDIT REFERENCE FROM YOUR TELEPHONE COMPANY THAT YOU ARE WITH NOW.

INSTALL COSTS FOR NEW:

.
FOR NEW RESIDENTIAL LINE, WE WILL NEED PAYMENT ON THE ACCOUNT IN THE AMOUNT OF $28.36, PLUS DEPOSIT, BEFORE THE TELEPHONE SERVICE CAN BE TURNED ON. IT CAN BE TURNED ON THAT SAME DAY AS LONG AS IT IS BEFORE 2:00PM.

DEPOSIT TO BE DETERMINED- PLEASE CALL THE OFFICE FOR MORE DETAILS