Customer Information

Service Agreement

*Required
Business Name, if applicable
Only if you are putting service in the business name
Business Phone Number
Applicant*
Mobile Number*
Employment*
Mother's Maiden Name*
Co-Applicant, has full account access
Mobile Number
Employment
Address of Service*
P.O. Box if used
City*
County*
State*
Zip Code*
Mailing Address, if different from above
P.O. Box if used
City
State
Zip Code
Do you own or rent your home?

OwnRent
Paperless Billing
Paper StatementE-mail Statement
E-mail Address (for paperless billing)
example@example.com
Automatic Bank Payment (Optional)

Electronic payments from your bank account or credit card. Withdrawn on or about the 10th of the month. Incorrect information will result in a service fee and any late fees applicable. Please double check your banking information.
Select Account

CheckingSavingsCredit Card (skip down to Credit Card section)
Name of Bank/Credit Union
Bank Phone Number
Bank/Credit Union Address
City, State, Zip code
Account Number
Routing Number
Signature
Credit Card Type
Credit Card Number
example: 1234 2345 3456 4567
Exp. Date

MonthDayYear
Date
3 Digit Security Code
example: 123
Signature
Digital T.V. Service
DigitalTV Packages

Local $39.95Basic $74.95 (includes Local)Expanded $89.95 (includes Local & Basic)
Movie Packages

Starz/Encore $12.95Showtime/FLIX/TMC $12.95Cinemax $14.95HBO $14.95
Premium Channels

NFL RedZone - $60 / SeasonAdult Channel - $16.95
Set Top Box - $4.95/each/month
(QTY) A Set Top Box Is Required For Each TV
cDVR Service (Cloud DVR)

100GB of Storage - $4.95300GB of Storage - $9.95
Addition cDVR Service, want to keep recordings separate from spouse or children?

100GB of Storage - $9.95300GB of Storage - $14.95
Please be aware all recorded shows will automatically delete after 6 months unless locked and saved.
Telephone Service

Landline phone service includes Caller ID & Call Forwarding. If you are a Windstream customer and would to like keep your number you must fill out a Port-In Form found on our website, this is required for Windstream to release your number to us.
Residential Line - $32.99Business Line, price will varyI do NOT want Long Distance
Published

YesNo
Directory Listing. There is an additional charge for each additional listing of .30/month.
Casey Exchange (641-746-XXXX)

Casey Connect Plus: . .10/minute/$3.95 monthly feeCasey Connect: .14/minuteOther
Non-Casey Exchange

Casey Communications: $11.00/month/500 minutes .05/Minute afterCasey Connect .14/minuteOther
If you want to keep your current carrier such as AT&T please list the PIC or CIC code. You will need to get that from your carrier.
Internet Service
Within the City of Casey, DSL Service

5/1Mbps - $44.9510/1Mbps - $54.9515/3Mbps - $59.9525/5Mbps - $64.95 not available at all locations.
Outside City of Casey, Fiber Service

25/25Mbps - $64.9550/50Mbps - $74.95100/100Mbps - $84.95200/200Mbps - $104.951/1Gbps - $199.95
Additional Router/s- $4.95 each
(QTY) Initial router included with Internet Service. Additional Router for shed/barn.
Static IP - $4.95 each
(QTY) Business use
Customer Proprietary Network Information (CPNI)
Authorized contacts can discuss account information. Authorized contacts will not be responsible for payment of your account. Certain call information will not be shared over the telephone regardless of authentication.

I want to add authorized users. Please list them.I do NOT want to add authorized users.
Authorized Contact 1
Authorized Contact 2
TERMS

This is a month-to-month service agreement. Services will be paid on a month-to-month basis until services are canceled by you or terminated by Casey Mutual Telephone Company. Casey Mutual Telephone Company can terminate for non-payment on your services in a timely matter.
FIRST MONTH BILLING

Your first bill may be higher than normal depending upon the date you are connected. It may include more than one month's charges.
CANCELLATION OR TERMINATION

If you cancel your services or Casey Mutual Telephone Company terminates your services, you agree to return the equipment in 7 business days from cancellation or termination or you will be billed for the equipment.

Business hours Monday- Friday 8:00A.M-12:00P.M 1:00P.M to 5:00P.M (except holidays).
Signature*
Date*

MonthDayYear
Should be Empty:

Service Agreement

Paperless Billing

Automatic Bank Payment (Optional)

Digital T.V. Service

Telephone Service

Internet Service

Customer Proprietary Network Information (CPNI)