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Application for Telephone or Internet
Please Call 254-646-2211 with any questions.
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Email
*
Your email
Applicant Name:
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Your answer
Please print name EXACTLY as you want it listed in the directory, if applicable.
Your answer
Date:
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MM
/
DD
/
YYYY
911 (Physical) Address
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Your answer
County:
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Your answer
City:
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Your answer
Do you live in Lipan City Limits?
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Yes
No
Contact Number:
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Your answer
Billing Address:
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Your answer
Nearest Relative Not Living With You:
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Your answer
Address for Nearest Relative:
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Your answer
Type of Service Requested:
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Residential
Business
Has this location had service before?
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Yes
No
Unknown
Has applicant had service with us before?
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Yes
No
If yes, what was your previous number?
Your answer
Please Select Services:
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Broadband up to 10 MBSP with Residential Phone ($64.95 plus phone)
Broadband up to 25 MBSP with Residential Phone ($74.95 plus phone)
Broadband up to 50 MBSP with Residential Phone ($84.95 plus phone)
Broadband Only up to 25 MBSP ($84.95, where available)
Broadband Only up to 50 MBSP ($94.95, where available)
Broadband Only up to 100 MBSP ($119.95, where available)
Broadband Only up to 500 MBSP ($144.95, where available)
Broadband Only up to 1 GBPS ($174.95, where available)
Business Phone Line
Residential Phone Line
I want my number non-pub @ $1.15 per month
Required
Additional Services
Additional services can be added by calling the business office at 254-646-2211. These services can be found here:
https://www3.lipan.net/wordpress/services/
For Government Reporting Purposes ONLY we are required t request the following information. Please note, responding to this question is optional.
RACE/ETHNIC GROUP:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
Hispanic or Latino
Not Hispanic or Latino
Clear selection
If you would like a password on your account please contact the business office at 254-646-2211.
Letter of Agency
If you wish to keep a Letter of Agency on your account pleases print from
http://www3.lipan.net/wordpress/important-links/
and return to the business office. Copies can also be picked up in the business office.
Public Notices
Please review the following Pubic Notices before submitting your application.
I have been given the option to read Lipan Telephone Company's Public Notices that can be found at:
http://www3.lipan.net/wordpress/important-links/
*
Yes
Send me a copy of my responses.
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