Change of Service Request Form

Change of Service Request Form

*designates a required field
Name (First & Last)*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Action*

Add new serviceMove existing service ($10 charge)Change existing serviceDisconnect
Internet- Inside City of Casey

5M- $44.9510M- $54.9515M- $59.9525M- $64.95
Internet- Outside City of Casey

100M- $74.95250M- $99.95500M- $139.951G- $199.95
Casey TV+ Streaming

Simple Package- $50.00/Month (2 Streams, 4 Devices & 100 GB of Storage)Prime Package- (Simple Included) $100.00/ Month (2 Streams, 4 Devices & 100 GB of Storage)
Premium Channel Add-Ons

Starz/Encore Package- $15.00/MonthCinemax Package- $15.00/MonthShowtime Package- $15.00/MonthHBO Package- $15.00/MonthAdults Only- $20.00/MonthNFL RedZone- $60.00/Month
Streams, Devices & Cloud

4 Streams/6 Devices-$20.00/Month300 GB of Storage- $10.00/Month
Telephone

Phone Service- $32.99Caller ID, Call Waiting, Call Forwarding- Free
Long Distance Plan
I (we) hearby authorize CASEY MUTUAL TELEPHONE COMPANY to make these changes to my (our) account.
Signature*
Date*

MonthDayYear
Date
Should be Empty: