Please check one of the following:

This application is for a residence.
This application is for a business.

Please enter your contact information below.
* = required field

Company Name (enter "n/a" if not applicable): *	Physical Address:
First Name: *	Mailing Address: *
Last Name: *	City: *
Daytime Phone: *	State: *
Evening Phone: *	ZIP: *
Email: *	Best Time to call:

Are you an existing Arkwest customer?

No
Yes

Please check the box next to the services you wish to enroll:

Telephone - Basic Local Service (click for information and pricing)
Basic Local Service
Telephone - Long Distance Service (click for information and pricing)
1+ Distance Service 800 Service Calling Card
Optional Calling Plans (click for information and pricing)
Intra-Company Optional Calling Plan Rural Saver Plan Circle Saver Plan	"1" + Saver 600 Minute Plan Designated Number Plan Extended Community Saver
Custom Calling Options (click for information and pricing)
Automatic Call Back Automatic Recall Call Forwarding Call Waiting Call Waiting-Distinct Ring Caller ID Caller ID Blocking (per call) Remote Call Forwarding Select Call Acceptance	Select Call Forwarding Select Call Rejection Speed Calling 8 Speed Calling 30 Teen Serivce 3-Way Calling Unknown Number Blocker Voice Mail Silver Voice Mail Gold
Digital Television Service (click for information and pricing)
Triple Play Basic Triple Play Plus Triple Play Premium Triple Play Premier Lifeline (Ala Carte) Basic (Ala Carte) Expanded Basic (Ala Carte) Mobile TV	Double Play Basic Double Play Plus Double Play Premium Double Play Premier 1 Movie Package 2 Movie Package 3 Movie Package 4 Movie Package
High-Speed Internet Service (click for information and pricing)
DSL High Speed Internet Service 512k/256k 768k/256k 1.544m/256k I need help deciding
Fiber-To-The-Home Internet Service 1.5m/1m 10m/1m 20m/1m

I have read the Service Agreement applicable to the services I have checked above and agree to its terms. I understand

that my use of the service(s) offered by Arkwest and/or VALTEC constitutes full acceptance of the terms of use of the

service, the same as if I have individually signed the agreement for service.