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Allendale Service Area
Coopersville Service Area
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TELEPHONE SERVICE APPLICATION

Allendale Communications

6568 Lake Michigan Drive, PO Box 509

Allendale, Michigan 49401

616-895-9911

PERSONAL INFORMATION

Name:
Service Address:
City: State: Zip: +
Contact Telephone Number:
Drivers License:
Social Security #:
Birth Date: - -
Spouse:
E-mail Address:
RELATIVE (Home Address If Student)
Name:
Address:
City: State: Zip: +
Telephone:
EMPLOYER INFORMATION
Name:
Address:
City: State: Zip: +
Telephone:

SERVICE INFORMATION

Requested Service Date: - -

Carrier (Long Distance) Information:

Intralata (616/231):
Interlata (US Calls [Non 616/231]):
International:

Published (No Monthly Charge) NonPublished ($1 monthly fee)

Phone Book/Directory Published Name (Last Name First Name): 

ex. Smith John K

Preferred Payment Method:

Regular Bill
Automatic Deduction
VISA/Mastercard

TOLL BLOCKS (OPTIONAL)

Toll Barred (All Long Distance Calls) $.50 Monthly

1 + Dialing N/C

011 (International) N/C

Bill To Third (Calls Billed To Your Phone From Another No.) N/C

0 + (Operator Calls) N/C

Collect Calls N/C

900 N/C

900 & 976 (Adult) N/C

CUSTOM CALLING

30-Number Speed Dialing $3.00 - Dial frequently called numbers with a code.

8-Number Speed Dialing $2.00 - Dial frequently called numbers with a code.

800 Only - Allows 800 calls, blocks all other long distance.

Anonymous Call Rejection $2.00 - Allows you to block calls from an unknown number.

Automatic Call Back $2.00 - Returns the last call received answered or not.

Call Forward All $2.00 - Transfers all incoming calls to another phone number.

Call Forward Busy $2.00 - Transfers incoming calls if your line is busy.

Call Forward No Answer $2.00 - Transfers incoming calls if not answered.

Call Waiting/Cancel Call Waiting $2.00 - Signals you that a second person is calling you.

Caller ID $4.00 - Identifies, by phone number, who is calling you before you answer.

Calling ID Plus $6.00 - Identifies, by name and phone number, who is calling you before you answer.

Distinctive Ringing $2.00 - When active, you get a special ring for callers you specify.

Do Not Disturb $2.00 - Gives the caller a busy signal unless they know your code.

Repeat Dialing $2.00 - Will try to get through to a busy line.

Selective Call Acceptance $2.00 - When active only allows preselected numbers to call you.

Selective Call Forward $2.00 - When active only forwards preselected callers.

Selective Call Rejection $2.00 - When active rejects calls from preselected numbers.

Three Way Calling $2.00 - Allows you to add a third party to an existing call.

Voicemail $3.00 - Answers calls when you are not able to.

Warm Line $2.00 - A preset number is called when you lift the receiver.

Comments or Concerns 

Service Activation . . . . . . . . . $32.00 - Including Tone
                                   + $ 5.00 - NonPublished at Install
Move Charge . . . . . . . . . . . . .$21.00
Number Change . . . . . . . . . . . .$21.00 - Published
                                     $26.00 - NonPublished
Name Change . . . . . . . . . . . . .$15.00
Carrier Change. . . . . . . . . . . .$ 5.00
Reconnect Charge. . . . . . . . . . .$21.00
© 2003 Allendale Communications