New Customer Application/Contract
Type(s) of Service:	Phone Video High-Speed High-Speed Wireless Dial-Up
Business Customer Information (required info)
Business Name: *
Primary Contact: *
Can be Reached #: *
E-mail Adress:
Secondary Contact Name:	(Joint Account)
Can be Reached #:
Mailing Address:
Physical Address: *
City: *
State: *

Additional Information
Previous Service with VTG?	Yes, No
Previous Telephone #:
Port Number to VTG:	Yes, No
Numbers to be Ported:
Terms and Conditions
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Valley Connections, L.L.C. Summary of Business Services Subscriber Agreement The following is a summary of the Business Services Subscriber Agreement (the “Agreement”) for services provided to you by Valley Connections, L.L.C. (“Connections”). The full text of the Agreement and the associated Acceptable Use Policy are posted at the Valley TeleCom Group website, www.vtc.net. You may also obtain copies by calling any Connections office. The full version will control in all cases. There are a number of “Services” (as set forth on this order form) to be provided by Connections which can include video, high-speed data and voice services. Your obligations and those of Connections are set forth in the Agreement, the Work Order for the placement of any equipment you order, any applicable provisions of the Acceptable Use Policy and, as appropriate, a “Tariff” describing charges that you may be required to pay Connections in those cases where rates are regulated by the Arizona Corporation Commission. Connections will notify you of any significant changes in any of these controlling documents (for example via a bill insert or bill message). Payment obligations. By signing the Agreement you agree to pay Connections on or before the due date for any use of Services, the installation charges, charges for damage to any equipment provided by Connections (if not returned in good condition) and all applicable federal, state and local taxes. You will be billed in advance for monthly recurring charges and other charges will be billed in the next feasible monthly billing cycle following use. You may also be charged late fees and early termination charges. Credit card billing is also available. Installation and maintenance. By signing the application for Services, the Agreement specifies that you will agree to allow Connections access to your house, apartment or other premises (including access easements) for both installation and maintenance of equipment during business hours and upon reasonable notice to you. If you are not the owner of the premises, by signing the Agreement you are warranting that you have obtained the consent of the owner of the premises for this access. If equipment is damaged, lost or stolen, the Agreement specifies that you will pay the replacement cost of the equipment as well as returning all equipment within ten working days of replacement or cancellation, including damaged equipment, to Connections. Use of Services. The Agreement specifies a number of limitations on the use of Services. These limitations, among others, include a prohibition against reselling or retransmitting, the use of local phone service for telemarketing, call center, medical transcription or facsimile broadcasting, the use of high-speed data service for the operation as an Internet Service Provider or any form of transmitter or wide area network that enables anyone outside of your residence to use Services. Support and Repair. The Services provided include Connections’ obligation to provide reasonable service and maintenance of the equipment upon your request. Connections will repair or replace equipment that has malfunctioned. You will be responsible for all wiring and other equipment that is not furnished by Connections, unless you obtained a service protection plan. Charges for Connections’ service that are not related to equipment malfunction or covered by a service protection plan are set forth in Connections’ price list posted at its website. Enforcement and Termination. If you violate the Agreement, Connections has the right to suspend or terminate all or a portion of Services without notification. If Services are suspended or terminated, you will not be charged for Services after the action, and will be refunded any pre-paid fees less any amounts due to Connections. Either Connections or you can terminate all or any portion of Services at any time for any reason by giving notice by mail or by phone as specified in the subscriber notification to set up an appointment to remove equipment. You cannot terminate Services by writing “canceled” or similar message on a bill or check. Early termination may result in penalties. Term of Agreement. The minimum term of agreement is selected on the New Customer Application Form. The term may be a component of the price plan you select. Early termination may result in penalties. (See Business Subscriber Agreement for full text.) Other provisions. The full Agreement contains disclaimers of warranty and limitations of liability, describes your privacy rights, and, unless you specifically request otherwise, consents to Connection’s calling you to market its current and future Services. You also have agreed that, unless specified otherwise, all notices may be made by electronic means (for example, email or online posting).
By submitting this form you are agreeing to Valley TeleCom Group’s terms and conditions
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