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BILLING INFORMATION (IF DIFFERENT FROM PROPERTY ADDRESS)
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Service Information
Desired Services * Do you have a high speed internet connection from another provider? If so, who? Do you have a wireless router? If known, please provide make and model of your router If subscribing to Life Watch, desired installation If subscribing to Phone, please check the services you would like Desired Caller ID Name How did you hear about us? NOTES
Secured Personal Information
Sensitive information is safe & secured on this form.Social Security Number * Drivers License Number * Drivers License State * Date of Birth * I agree to Allband Multimedia’s Terms and Conditions, Acceptable Use Policy, and Privacy Policy. I also give permission for Allband to perform a credit check, and charge a security deposit, if deemed necessary. I understand that if I do not supply a social security number, eligibility will be denied.Signature * Date Allband Communications Cooperative is the recipient of Federal financial assistance from the U.S. Department of Agriculture (USDA). The USDA and Allband Communications Cooperative prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual's income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA's TARGET Center at (202) 720-2600 (voice and TDD). If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form found online at http://www.ascr.usda.gov/complaint filing cust.html or at any USDA office, or call (866) 632-9992 to request a form. You may also write a letter containing all of the information requested in the form. Send your completed
complaint form or letter to USDA, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or fax to (202) 690-7442 or email to program.intake@usda.gov. Allband Communications Cooperative is an equal opportunity provider and employer. 
Join our Fight!February 1, 2018 - 6:33 am
Bovine TB Management HuntDecember 18, 2017 - 10:29 pm
Wildlife & Habitat Management InitiativeNovember 7, 2017 - 9:34 pm