Casey Mutual Telephone Company_Application for services

Casey Mutual Telephone Company

Application for Service

Casey Mutual Telephone Company 108 E. Logan PO Box 207 Casey, Iowa 50048

(641)746-2222/ Fax (641)746-2221
Applicant
Mobile Number
Employment
Mother's maiden name
Co Applicant
Mobile Number
Employment
Name of Business (if applicable)
Address of Service
Do you Own or Rent your home?

OwnRent
City
County
Zip Code
Mailing Address (if different than Service Address)
City
County
Zip Code
Email or Paper Statement?

Email StatementPaper Statement
Email Address
Customer Proprietary Network Information (CPNI)

Authorized contacts can discuss account information and make changes to your account. Authorized contacts will not be responsible for payment of your account. Certain call information will not be shared over the telephone regardless of authentication
CPNI

I do want to add authorized usersI do NOT want to add authorized users
CPNI-Authorized Users
Internet Services- Outside City of Casey

100/100 Mbps ($74.95)250/250 Mbps ($99.95)500/500 Mbps ($139.95)1/1 Gbps Mbps ($199.95)
Internet Services-Inside City of Casey

5M/1M ($44.95)10M/1M ($54.95)15M/3M ($59.95)25M/5M ($64.95)
Internet Service Additional Options

Additional Router/s (initial router included with internet service)Static IP (Business use)
Quantity of Additional Routers- $4.95 Each
Quantity of Static IP's (Business use)- $4.95 Each
Streaming Packages

Simple- Simple Channels Only ($50.00)Prime- Simple and Prime Channels ($100.00)
Premium Channel Add-Ons

Stars/Encore ($15.00)Showtime ($15.00)Cinemax ($15.00)HBO ($15.00)Adult Channel ($20.00)NFL RedZone ($60.00/Season)
Streams, Devices, & Cloud

4 Streams & 6 Devices ($20.00)300 GB of Storage ($10.00)
Telephone (Landline) Services

Residential Phone Service ($32.99)Business Line (Price will Vary)
Do you wish to keep your current phone number?

Yes- Aureon Port Form needs filled out. Contact Casey Mutual for assistance.No- Assign me a phone number
Long Distance Packages (Check all that apply)

Casey Exchange (641-746-XXXX) (Casey Customers ONLY)Casey Connect: $0.14/Minute/No Monthly Fee (Casey Customers ONLY)Casey Connect Plus: $0.10/Minute/$3.95 Monthly Fee (Casey Customers ONLY)Non Casey ExchangeCasey Connect: $0.14/Minute/No Monthly FeeCasey Communications: $11/Monthly for 500 Minutes ($0.05/Minute after the 500 Minutes)No Long Distance
Phone Book Publishing

YesNo
Directory Listing
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.

Canecllation 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. Business hours Monday-Friday 8:00 AM-5:00 PM (except holidays).

First Month Billing

Your first bill may be higher than normal depending upon the date you are connected. It may included more than one month's charges.
Customer Signature

Clear
Date

MonthDayYear
Date
Direct Payment (Optional)

Electronic payments to your bank account or credit card are available. Withdrawn on the 10th of the month. For more information and to sign up for direct payment please email info@caseytelco.com or call the office at 641-746-2222.
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