Home Phone Service
Serviço Telefono de Casa
Provided by: Arizona Dialtone, Inc.

Start Up Fees A'la Carte
Non-Refundable Initial Service Fee*

[ ] Essential Package
[ ] Essentials PLUS voicemail

Other Options Available!

Total Due 		$55.00

$39.99
$47.98

 

$________
Non-Refundable Initial Service Fee*

[ ] Basic Service

[ ] Inside Wiring Maint.
[ ] Call Waiting
[ ] Call Return (*69)
[ ] Three-Way Calling
[ ] Call Forwarding
[ ] Caller ID
[ ] Voice Mail (no stutter)

Total Due		 $55.00

$29.98

$2.99
$5.00
$5.00
$5.00
$5.00
$5.00
$8.95

$________
*The initial service fee must be included before service can begin.

Customer Information:

Name (First/Last):________________________________________________

Address:__________________________________________________________

City:___________________________________ State:_____ Zip:_________
Customer Contact #
(Pager, Cell, Work, Neighbor)_____________________________________

Referral Information:

Referring Customer's Name:________________________________________

Referring Customer's Phone#:______________________________________

Referring Customer's Account#:____________________________________

To Sign Up: Call 800-736-3261 Weekdays 8:00-5:00
Or print and complete this application and do one of the following:
Mail check, money order, Visa, Mastercard, with this application to the address below.
Or fax this application with Visa or Mastercard information to the fax number below.
Or bring your payment with this application to the address below.
  Arizona Dialtone
6115 S. Kyrene Road
Tempe, AZ 85283
FAX: 480-889-1995
Please do not send cash through the mail.

 

LETTER OF AGENCY AND AGREEMENT

To the Incumbent Local Exchange Carrier (ILEC),

The undersigned appoints Arizona Dialtone, Inc. (AZDT) as agent to order changes to and maintenance on specific telecommunications services you, the ILEC, provided to the undersigned, including, without limitation, removing, adding to or rearranging such telecommunications service.

You, the ILEC, are hereby released from any and all liability for making pertinent information available to AZDT and for following AZDT's instructions with reference to any changes or maintenance on the undersigned's telecommunications service.

You, the ILEC, may deal directly with AZDT on all matters pertaining to said telecommunications services and should follow AZDT's instructions with reference thereto. This authorization will remain in effect until otherwise notified in writing by both parties.

In closing, I have read, understand, and agree to all terms and conditions.


Signature_____________________________ Date ______________
Credit Card Information:

[ ] Visa:________________________________________________

[ ] Mastercard:__________________________________________

[ ] Numbers on Back______________________________________

[ ] Expiration Date:_____________________________________

[ ] Name on Card:________________________________________

[ ] Amount to Charge:____________________________________

[ ] Authorized Signature:________________________________

 

Driving Instructions:
Take the I-10 freeway to the Baseline Road exit.
Drive East to the light at Kyrene Road, turn Right (south) on S.Kyrene Road
Approzimately 3/4 Mile on left.
We are located at the NE corner of W. Gemini and S. Kyrene

During office hours, bring your payment inside.




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