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.

COSTS FOR NEW PHONE:

CABLE PRICES:   W/DSL $57.45 + $4.02 (TAX) = $61.47

                              W/O DSL $62.45 + $4.37 (TAX) = $66.82

DSL PRICE: 256K $28.00/$26.00

                     384K $44.95

                     512K $59.95

THE PRICES FOR CABLE AND DSL IS WITH A 2YR SIGNED LEASE. IF YOU DO NOT WANT TO SIGN A LEASE THERE IS A RENTAL POLICY THAT WILL BE $7.50/MONTH PER PIECE OF EQUIPMENT.

ALSO, ANY ADDITIONAL CABLE BOXES, AFTER THE FIRST ONE ON THE LEASE, IS $7.5O/MONTH ALSO.

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FOR NEW RESIDENTIAL/BUSINESS LINE, WE WILL NEED 1ST MONTH 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.

DEPOSITS ARE AS FOLLOWS:

LOCAL SERVICE/LONG DISTANCE

RESIDENTIAL LINE $50.00/$125.00    BUSINESS LINE $60.00/$125.00

INTERNET  256 $28.00/$26.00

                    384  $50.00

                    512  $60.00

CABLE  $60.00 W/DSL

              $70.00 W/O DSL