Membership, Credit and Service Application

Transcription

1 Membership, Credit and Service Application 510 Broadway PO Box 136 Abercrombie, ND T: F: Date Membership # Phone # Assigned 1. Billing Name and Address (please print) Name Address City State Zip Code 2. Past Service Information Home telephone # Cell Phone # Previous phone # Have you had service with our company before? Residential Social Security # If yes, when? Business Incorporated Fed. ID# Bus/Res. Not available in all exchanges, must meet specific criteria Date service is to be connected 3. Credit Information Do you rent your home? Yes No If yes, landlord's name Employed by: years Spouse employed by: years Work phone: Applicant Spouse Name & phone # of relative not living with you who knows where you can be reached: Relationship: Phone # 4. Service Location Information Has there ever been telephone service at this location? Yes -- Who lived here last? No -- Provide township, range & section or directions. 911 address County Name of nearest neighbor MEMBER SERVICE AGREEMENT THE UNDERSIGNED hereby applies for membership in the Red River Rural Telephone Association, a Minnesota Cooperative (hereinafter called the Cooperative. ) As a part of this application, the undersigned agrees as follows: (a) To purchase from the Cooperative telephone service as specified in the Bylaws of the Cooperative, and, after obtaining membership, continuing to receive service: and (b) To comply with and be bound by the Articles of Incorporation and Bylaws of the Cooperative, and, any rules and regulations adopted by the Board of Directors. (A copy of the Bylaws can be found in our telephone directory.) Applicant's signature (if signing for a business, please include your title) (To be filled out by the Telephone Company) The above application for membership accepted by resolution this day of, 20 Red River Rural Telephone Association By President of Cooperative

2 BILLING NAME AND ADDRESS INFORMATION The Federal Communications Commission (FCC) has directed all local telephone companies to provide a subscriber s billing name and address (BNA) data to long distance carriers when (1) the subscriber accepts a third party or (2) the subscriber has placed a call using a long distance carrier other than the company to which the caller is presubscribed. The BNA information will only be provided when necessary for the long distance carrier to issue proper billing. The FCC has directed that your Billing Name and Address data can only be used by the long distance carrier for billing purposes. CALLING FEATURES & MONTHLY CHARGES Auto Callback $1.50 Auto Recall $1.50 Call Forwarding Basic $1.00 Call Forwarding - Busy Line $1.50 Call Forwarding - Don t Answer $1.50 Call Forwarding - Fixed $2.00 Call Waiting $1.00 Call Waiting ID (requires Caller ID) $2.00 Caller ID Number Only $3.00 Caller ID Name & Number $4.50 Distinctive Incoming Ring $5.00 Distinctive RNG/CWT $1.50 Inside Wire Maintenance $1.25 Originating Call Management $3.50 Selective Call Acceptance $1.50 Selective Call Forwarding $1.50 Selective Call Rejection $1.50 Speed Dial - 8 numbers $1.00 Speed Dial - 30 numbers $2.00 Telemarketer Call Screening $ Way Calling $1.00 Voice Mail Basic $3.95 Voice Mail Enhanced $4.95 SERVICE RESTRICTIONS Allow 3rd party billing Call charges apply Allow collect calls Call charges apply Caller ID line blocking (residential) No charge International call block No charge 900 numbers block No charge Restrict long distance calls No charge Listed Unlisted Non-published ($1/month) Directory Name Directory Address Additional Listing (25 per month) Customer Owned DIRECTORY EQUIPMENT Leased COMMOM CENTS PROGRAM Red River Communications has a Common Cents program in which customers have their monthly bills rounded up to the nearest whole dollar and the additional amount is pooled in a fund to assist local communities and nonprofit organizations. Funds collected help improve life within our communities. New customers are automatically enrolled in the Common Cents program. Participation is optional and you may change your participation at any time. MARK THE BOX BELOW IF YOU DECIDE NOT TO PARTICIPATE IN THE COMMON CENTS PROGRAM. Remove my account from the Common Cents program. FOR OFFICE USE ONLY ADDITIONAL SERVICES/NOTICES Type of service: Residential Business Business/residential Automatic payment options: Auto bank pay Credit card E-bill CPNI form returned Long distance carrier selected Any interest in the following services: Internet SecureIT Cellular Deposit required? Y / N Amount $ Date paid COMMENTS/NOTES

3 ACCOUNT PRIVACY (CPNI) Form The FCC mandates that all telecommunications companies safe guard Customer Proprietary Network Information (CPNI) data. In general terms, CPNI is personal information stored and collected by Red River Communications for billing and provisioning service. Examples of protected information include call detail, services and features subscribed to and carrier selected. Examples of non-protected information, because it is of public record, include name, address and phone number if published. Red River Communications will do everything possible to protect the privacy of your CPNI information. Part of the rule changes by the FCC requires Red River Communications to perform a customer authentication process anytime you call for protected information about your account or if you come into the office. The following procedures have been put into place by Red River Communications to comply with these requirements. If you come to the office for information, please bring a copy of your complete bill with you. If you do not have your bill you will need to provide a valid photo ID before we can share information on your account. If you are calling the office, you need to provide your CPNI password to allow us to share information about your account. Please create a CPNI password that you would like to use. Security questions may be set up on your account in the event you call our office to inquire about your account and do not remember your password. Answering these security questions will allow you to access your account. Please fill out at least one of the security questions and answers below. Additional Authorized Contacts: In addition, information will only be given to the name of the person on the account. If you would like other people (husband, wife, family, etc) to have access and/or make changes, please provide the names below of those whom you wish to have access to your account. Remember, all contacts will need to know the password and security questions when they call in to our office. Thank you for assisting us in protection your information. If you have any questions, please call our business office at or Account Holder Name: Typed or Printed Signature Password: Phone #: Please provide a simple question(s) and answer(s) for the times you need to contact Red River Communications. Common information such as mother s maiden name, birthday, home address or social security number should NOT be used as a password. Question 1: Pets name(s)? Answer: Question 2: Favorite color? Answer: Question 3: Answer: (Create your own question) Please identify any additional authorized contacts: Additional Authorized Contact: Additional Authorized Contact:

4 LONG DISTANCE CARRIER SELECTION & FREEZE FORM Please complete and return this form to Red River Communications. Subscriber's Name Requested by Phone # CARRIER SELECTION: Long distance service is divided into two calling areas called intralata and interlata. Long distance companies may choose to serve one or both LATAS. This map is also shown in the front section of the telephone directory. A list of available carriers can be viewed on our website at redrivercomm.com/about/applications/long-distance-carrier-list/. The Fargo/Brainerd area in white is your intralata calling area. Everywhere outside the white area is your interlata calling area. interlata: change from present carrier to new carrier Carrier's 4-digit ID code (shown on long distance carrier list): intralata: change from present carrier to new carrier Carrier's 4-digit ID code (shown on long distance carrier list): To ensure proper billing, please contact carriers when selecting or disconnecting their services. FREEZE REQUEST (optional) To avoid being "slammed," meaning your long distance carrier(s) is changed without your permission, you can "freeze" your long distance carrier(s). With a "FREEZE" NO carrier change can be made UNLESS you contact your local telephone company. A "FREEZE" is FREE. You must contact Red River Communications to remove a freeze. Freeze my carrier(s) for both LATAs. OR Freeze just my intralata carrier. Freeze just my interlata carrier. Signature Date

5 What You Need to Know About Credit Checks & Deposits Each applicant is required to pass a credit check or supply a deposit prior to receiving telephone service. CREDIT CHECK: A credit check is processed on the applicant with their permission. The following information is required for the credit check: 1. first and last name of the applicant, 2. current location for utility service ( electric or telephone), 3. social security number for an individual or EIN for a business, 4. primary or home phone number, and 5. date of birth Depending on the credit check results, a deposit may be required. DEPOSITS: You may submit a deposit amount which varies depending upon what type of service you wish to receive: 1. Local telephone service - $50 This service allows you to placelocal calls only. Other types of calls are NOT permitted, including toll-free (800, 888, 877, 866) or operator-assisted (O+) calls. You are not able to accept collect calls. 2. Local, long distance & 800 service - $100 This service allows you to place any type of local or long distance call - subject to your own restrictions. 3. Additional deposits may apply for cellular, wireless, high-speed Internet, or other services. MORE ABOUT DEPOSITS: Deposits received for telephone service are held for a minimum of one year. Interest is earned on the amount of the deposit for telephone service only. After one year, your telephone or other services on the accunt is reviewed. If the account has no 30day balances, past-due notices, disconnects for non-payment or NSF charge., the deposit with interest will be refunded in the form of a check. Any deposit refunded in the form of a check will be made payable to the person or business whose nameis on the account If the account information contains any of the items listd above, the deposit will continue to be held until the account has not received any treatment for 12 continuous months. Interest earned will be credited annually to the telephone account. When telephone service is permanently disconnected, approximately two billing cycles will pass in order for any additional toll charges to be received before the deposit and interest will be refunded. Any outstanding balance and toll charges will be deducted from the deposit before it is refunded. If you have any questions, please contact our office at or toll-free within our telephone exchanges. Red River Communications 510 Broadway PO Box 136 Abercrombie, ND membersupport@redrivercomm.com redrivercomm.com

6 Auto Bank or Credit Card Pay Authorization Form Automatically pay your monthly bill! AUTHORIZATION FORM FOR AUTOMATIC PAYMENT I authorize Red River Communications and the financial institution named below to initiate entries to my checking account or credit card. This authorization will remain in effect until I notify the company in writing to cancel it. Red River Communications will have a reasonable oppor-tunity to act on it. I can stop payment by notifying my bank 3 days before my account is charged. I can have the amount of an erroneous charge immediately credited to my account up to 15 days following issuance of my bank statement or 60 days after posting, whichever occurs first. ( Company) (Billing Name - please print) (as it appears on bill) (Telephone Number) (Address) (City, State, Zip Code) (Signature) (Date) Monthly Credit Card Payment or Auto Bank Pay (Deduction from credit card or auto bank occurs on 6th to 8th each month) Please send a voided check Credit Card Number Billing name as it appears on Credit Card (Please Print) Credit Card CVV/CVC (Last three digits on signature line on back of card) Expiration Date Month Year Sign up for Auto Bank or Credit Card Pay and get a $5 credit! Your Red River Communications bill will automatically be paid every month without worry. Call us today at or to sign up for Auto Bank Pay or Credit Card Pay! A one-time $5 credit for signing up for Auto Bank or Credit Card Pay will be applied to your account. (Financial Institution Name) (Financial Institution Address) (City, State, Zip Code) _ (Bank Transit Number) _ (Checking Account Number) If you have any questions please call Red River Communications at or toll-free. Return form to: Red River Communications PO Box 136 Abercrombie, ND or membersupport@redrivercomm.com

7 ONLINE BILL PAY It s free and easy! View & pay your bill online with SmartHub. Avoid payments lost in the mail. Get your bill faster! Check it online the day it s processed. Maintain control over when your bill is paid. Pay by check or credit card! View your billing AND payment history. Set up recurring payments. Go green with paperless bills. Have it sent to your . How to sign up for Smart Hub e-bill: 1. You will need the most recent copy of your bill. 2. Visit on the internet. 3. Select the Pay my bill link on top of the web page. 4. On the Account Login page, click the User Registration link. This link is located in two places: in the red menu above the login screen as well as the text link below the login screen. 5. With the most recent bill in hand, complete the User Registration and submit your information. Pay particular attention to how the name is listed on the bill to avoid problems registering your account. 6. Follow the remaining on-screen instructions to confirm your user information and login to your new Red River Communications e-bill account. How to pay your bill online: 1. Visit on the internet. 2. Select the Pay my bill on top of the web page. 3. Enter the and password used during the registration process. 4. You account should be listed with your current balance due listed. All your Red River accounts will be listed separately if you have more than one account registered. 5. Click the Pay button to pay the balance. If you would like to pay an alternative amount, enter the amount you wish to pay in the white Pay field. 6. Click the preferred payment and complete the on-screen prompts to complete your payment. Red River e-bill accepts payments from checking/savings accounts and credit/debit cards. *You must manually pay your bill online just as you normally did with your paper bill. If you prefer automatic monthly payments, then please call to inquire about Auto Bank Pay. If you experience any problems signing up for e-bill, call our office at or click the new Web Chat button on our website Monday-Friday between the hours of 7:30am-4:30pm for assistance. A division of Red River Rural Telephone Association