Cable and Phone Service Management

Cable and Phone Service Management

Resident Trust (RT) account authorization is required to activate this section. This section is unlocked only after RT account authorization is selected.
Do you or the resident for whom you are Responsible for have a Resident Trust Account already established at Andrus on Hudson?*

YesNo
Resident Name*

First NameLast Name
Room Number*
Telephone:

Incoming calls are included. Outgoing phone service is $15.00 per month. Prices are subject to change based on market and provider costs, and you will be notified in advance of any changes. A Resident Trust (RT) account authorization is required to activate this section.
Television:

Cable TV service is currently $31.00 per month. Prices are subject to change based on market and provider costs, and you will be notified in advance of any changes. A Resident Trust (RT) account authorization is required to activate this section.
Resident Name*

First NameLast Name
Facility Name*
Read-only
Monthly Allowance Amount*
Revocable (May be closed prior to death.)
Who is completing this authorization?*

ResidentResident Responsible Party
Resident Signature Name*

First NameLast Name
Please bill the resident's resident trust, personal allowance account for*

Telephone Services - $15.00 per monthCable TV Service $31.00 per month
Name of Signee*

First NameLast Name
Resident Signature or Responsible Party Signature *
Date

MonthDayYear
Date
Should be Empty: