Name:
Email Address:
Contact Phone Number:
Social Security Number:
Date of Birth:
Marital Status:
Service Address:
Employer:
Years Employed:
Position:
Employer's Address
Employer's Phone:
Previous Employer (if less than one year):
Years Employed:
Position:
Name:
Social Security Number:
Date of Birth:
Employer:
Employer's Phone:
Years Employed:
Position:
Please List other Adults with Access:
Current/Previous Telephone Company:
Current/Previous Telephone Number:
Current/Previous Address (if different from above):
Do you Own or Rent Property?
If you rent, Landlord's Name:
Landlord's Telephone Number:
Name:
Address:
Relative's Telephone Number:
Relationship:
Local Residential Rate
$5.60 - Does not include regulatory charges, taxes, and other surcharges
Name:
Are you interested in automatic bank draft?
Directory Publishing:
Inside Wire Maintenance:
Voice Mail Bronze Package
Voice Mail Silver Package
Voice Mail Gold Package
Voice Mail Platinum Package
Class Services:
(1) Teen Service - $3.95 (2) Automatic Call Back *66 - $4.50 (3) Automatic Recall *69 - $ 4.50 (4) Calling Number Delivery - $ 6.50 (5) Dialable Number Delivery - $7.50 (6A) Calling Number/Name Delivery - $7.50 (6B) Dialable Number/Name Delivery - $8.50 (6C) Caller ID on Call Waiting - $2.00 (7) Call Block *60 - $ 3.50 (8) Distinctive Ringing/Call Waiting - $ 3.50 (9)Selective Call Forwarding - $3.00 (10) Avoid-A-Call - $2.50 (10A) Anonymous Caller Rejection - $1.00
Custom Call Features:
Speed Calling 8 - $1.60 Speed Calling 30 - $2.55 Call Waiting - $ 1.60 Three Way Calling - $ 1.60 Call Forwarding - $1.60
Choose a carrier:
Brandenburg Telephone Long Distance Calling Cards
Please freeze my long distance carrier so only I can change:
It is your responsibility to contact your carrier if choosing a provider other than Brandenburg Telephone Long Distance. These long distance charges may not appear on your local phone bill. We will make every effort to ensure that your telephone service is connected to the Long Distance Company you choose. In the event your service is inadvertently connected to a different company, we will assume liability only to the extent of connecting your chosen company at the earliest opportunity after you notify us.
Choose a package:
16 local channels from Bowling Green, Elizabethtown, Lexington, Louisville, 7 Pay-Per-View access channels, C-Span, C-Span2, QVC, WGN, Local Weather and Home Shopping Network.
DV-Basic (DVB) plus 58 premium TV channels and 45 music channels.
DV-Gold 166 channels including DV-Basic
Additional Packages:
Add this package to DV Basic or DV Deluxe to get 9 additional Sports Entertainment channels. TVG, Fuel, Fox Soccer, Fox College Sports Pacific, Central, Atlantic, Español, The Speed Channel & ESPNU.
Add an additional 24 channels including Speed, Boomerang, Discovery Kids, ESPNU, Noggin' and much more!
Add this package to DV Gold to get WAVE3, WLKY32, WHAS11 & FOX41 in HD.
Add this package to DV Gold to get HD Local package plus Discovery Channel, ESPN, ESPN2, HD Movies, HD Net, The Learning Channel, Discovery Theater, national Geographic, *Showtime & *Starz
*HD customers must subscribe to Showtime and/or Starz to receive these channels in Hi-Definition.
Channels
Price
$12.95
$14.95
Showtime with Showtime 2, Showtime Beyond, Showtime Extreme, Movie Channel, Showtime Showcase, Showtime Next, Showtime Family, Showtime Woman, Movie Channel, Movie Channel 2, and FLIX
$14.95
$11.95
$27.95
$27.95
$27.95
$27.95
$27.95
$27.95
$37.95
$37.95
$37.95
$37.95
$45.95
Adult Programming also available upon request. Please contact our office for more details.
DSL Customers are required to have an Ethernet card (NIC) installed prior to scheduled appointment. DSL Customers must have local phone service with Brandenburg Telephone Company
Username (6-14 characters):
Password (4-8 characters):
If left blank and selecting any internet plan we will contact you for this information.
Do you have a burglar alarm?
Phone Line Alarm is Connected To:
Your estimated installation charges, 1 month charge on Digital Video and/or DSL and deposit (if required) must be paid prior to installation. Our office will contact you to discuss applicable charges prior to installation.
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