****Please answer the Following Questions****
You will need to use this password or know the answer to one back-up question when calling in to discuss your account or make any changes to your account
Authorized User(s) to request info or make changes to your account
Account Access Password
Answer two of the following back-up questions
What is your favorite holiday?
What is your favorite vacation location?
What is your mother’s maiden name?
What town were you born in?
Preferred E-Mail address
Cell Phone Number
Would you like information on paperless billing or auto bank collect?
Yes
No
The undersigned, hereinafter called the “Applicant”, hereby applies for telephone service with Nelson Communications Cooperative, a corporation duly organized and existing under and by virtue of the laws of the State of Wisconsin, hereinafter called the “Cooperative”, for the purpose of having furnished to said “Applicant” telephone services upon the following terms and conditions:
The “Applicant” will take from the “Cooperative” telephone services when available and will pay monthly rentals to the “Cooperative” in accordance with the rate schedules and rules and regulations established by the “Cooperative” in accordance with the directives of the United States of America and the State of Wisconsin and their regulatory bodies.
The “Applicant” hereby grants to the “Cooperative”, a right-of-way easement to construct, operate and maintain a telephone line or system on its or his premises and in or upon all streets, roads or highways abutting said premises, and also such service lines are necessary, and also the right to cut or trim trees and to bury cable necessary to the efficient operation of said system. The “applicant” will comply with and be bound by the provisions of the bylaws, rules and regulations of this Association and such amendments as may from time to time be adopted.
AGREE TO TERMS
Signature (Type in First, Middle Initial and Last)
Date