Current Internet Subscriber Requesting Phone Service Step 1 of 4 25% Please complete the form below to the best of your ability. At the end of the form you will see a comment box where you can ask questions or pass on instructions. RESIDENTIAL OR BUSINESS SERVICE?*ResidentialBusinessBusiness level service includes 24/7 technical support, and the ability to be listed in phone directory as a business. Home businesses without these requirements may subscribe for Residential service.BUSINESS NAME*that business service is not required to run a home business; however, business accounts do receive 24-tech support and can have their businesses listed in phone directories.SUBSCRIBER'S NAME* First Last BUSINESS CONTACT PERSON*BEST CONTACT PHONE NUMBER*SERVICE ADDRESS* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code EMAIL ADDRESS* Enter Email Confirm Email Most of the communication between LymeFiber and the subscriber will be via email, so please be sure to check that the email address is correct. If your address is with @gmail.com or @aol.com please add support@LymeFiber.net to your anti-spam whitelist and/or add it to your contacts list to avoid missing communications. WOULD YOU LIKE TO KEEP YOUR CURRENT PHONE NUMBER?*I would like to keep my existing phone numberNo, please issue me a new phone numberIt is imperative that you do not cancel your existing phone service prior to our installer completing and testing Internet and phone service at the location. Doing so risks losing your number.If you are keeping an existing number, we require a signed "Letter of Agency", which you can download here Please return the completed form to us either via email to email@example.com, place it into the dropbox at the front of our building, fax (802.763.2221), or via US mail: 415 Waterman Road, Royalton, VT 05068. You can also click the Electronic Signature form and fill out the form online and it will be automatically linked to your account. Online Electronic Signature Form "Phone Letter Of Agency": https://www.ecfiber.net/phone-letter-of-agency-loa/ If you checked the box to keep your existing number you will receive an email of this form. WE CANNOT SCHEDULE AN INSTALL WITHOUT A SIGNED COPY OF THIS DOCUMENT IN OUR POSSESSION so please return it as soon as possible. MY CURRENT PHONE NUMBER(S)*Additional residential phone lines may be ordered at $25 per month per line.ADDITIONAL RESIDENTIAL PHONE LINES (If yes, how many?)Additional residential phone lines may be ordered at $20 per month per line.NUMBER OF ADDITIONAL BUSINESS TELEPHONE NUMBERSAdditional business phone lines may be ordered at $35 per month per line. HOW WOULD YOU LIKE YOUR OUTBOUND CALLER ID FORMATTED?*(i.e., How should your name displayed on your friend's phone when you call?). Please note you are limited to 15 characters, including spaces, and that no special characters are allowed except commas and periods!DIGITAL VOICEMAIL SERVICE (optional) Add voicemail service Do you wish to access our Digital Voicemail Service at no additional cost. Our voicemail service allows one to check messages from any phone or web browser and includes the option to have actual voice messages sent to multiple email addresses. *Please note, this will replace your personal answering machine service. THE LOCATION HAS A SECURITY SYSTEM*YesNoWe need this information to determine what equipment we will use during the install.CONTRACT FEES WITH YOUR CURRENT PROVIDER* I Agree I understand that I am responsible for any early contract termination fees levied by my current phone provider (I.e., Fairpoint/Consolidated, Comcast, Exede, Wildblue, WaveComm etc). SPECIAL INSTRUCTIONS, COMMENTS, OR QUESTIONSPlease include any special instructions or questions you have for our team.TERMS AND CONDITIONS* I have read and agree to the terms and conditions set forth in the LymeFiber Subscriber Agreement NOTE: LymeFiber has no contracts.PLEASE TYPE YOUR NAME*By typing your name you agree that you have answered all of the previous questions to the best of your ability.