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Application For Telephone or Internet
Please call 254-646-2211 with any questions.
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* Required
Applicant Name:
*
Your answer
Please print name EXACTLY as you want it listed in the directory, if applicable.
Your answer
Date:
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Your answer
911 (Physical) Address:
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Your answer
County:
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Your answer
City:
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Your answer
Do you live in Lipan City Limits?
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Yes
No
Contact Number:
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Your answer
Billing Address:
*
Your answer
Nearest Relative Not Living With You:
*
Your answer
Address for Nearest Relative
*
Your answer
Type of Service Requested:
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Residential
Business
Has this location had service before?:
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Yes
No
Unknown
Has applicant had service with us before?
*
Yes
No
If yes, what was your previous number?
Your answer
Please Select Services:
DSL Up to 3MBPS with Residential Phone ($40.95 plus phone)
DSL Up to 5MBPS with Residential Phone ($60.95 plus phone)
DSL Up to 8MBPS with Residential Phone ($74.95 plus phone)
DSL Up to 10 MBPS with Residential Phone ($99.95 plus phone)
DSL Only Up to 15MBPS ($119.96, where available)
DSL Only Up to 25MBPS ($129.96, where available)
DSL Only Up to 50 MBPS ($174.96, where available)
Business Phone Line
Residential Phone Line
I want my number non-pub @ $1.15 per month
Additional Services
Additional services can be added by calling the business office. These services can be found here:
http://www3.lipan.net/wordpress/services/
For Government Reporting Purposes ONLY we are required to request the following information. Please note, responding to this question is optional. RACE/ETHNIC GROUP:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Hispanic or Latino
Not Hispanic or Latino
Clear selection
If you would like a password on your account please contact the business office.
Letter of Agency
If you wish to keep a Letter Of Agency on your account please print from
http://www3.lipan.net/wordpress/important-links/
and return to the business office. Copies can also be picked up anytime at the business office.
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