Arkansas Telephone Company
Application for Service

    Select (if applicable)
    ElderlyHandicapped

    Service Request:
    New ServiceNumber ChangeName Change

    Type of Service:
    ResidenceBusiness

    Type of Phone:
    White -
    WallDeskCOE

    Ivory -
    WallDeskCOE

    In making this application the applicant agrees to the rules and regulations of the Telephone Company as set forth in the exchange tariff, and to any general changes in rules or rates for the service furnished under this application. This application becomes a contract when accepted in writing by the Telephone Company.

    IF APPLICANT'S CREDIT RATING IS NOT FOUND TO BE SATISFACTORY, A CASH DEPOSIT WILL BE REQUIRED. DEPOSIT MAY BE INCREASED IF PAYMENTS ARE LATE OR TOLL IS EXCESSIVE.



    Drivers License Information:

    Important: Please attach a copy of your driver's license.



    Co-Applicant Drivers License Information:

    Important: Please attach a copy of your driver's license.