Application For Telephone or Internet
Please call 254-646-2211 with any questions.
Applicant Name: *
Please print name EXACTLY as you want it listed in the directory, if applicable.
Date: *
911 (Physical) Address: *
County: *
City: *
Do you live in Lipan City Limits? *
Contact Number: *
Billing Address: *
Nearest Relative Not Living With You: *
Address For Nearest Relative: *
Type of Service Requested: *
Has this location had service before?: *
Has applicant had service with us before? *
If yes, what was your previous number?
Please Select Services:
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:
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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