Canby Telcom

Care

Business Service

Service Request Form - Business

View the Consent for Service

Business Information


Business Name
SSN/Federal Tax ID Number
Corporate (inc. LLC, S-corp, etc.)
Sole Proprietorship
Parnership (inc. LLP, etc.)
Agency
Business Type

Address

City State Zip
Last Business Address
Yellow Page Listing
As a business subscriber, CT will provide a free
yellow page listing in the NWV Directory. Please
describe the Main Class Heading you would
perfer to be listed under.

 
 Main Class Heading

 http://
Web Address

Contact Information


First Name
Last Name
Middle Initial
19
Date of birth
Oregon Drivers License
Contact phone number:

Employed by
Occupation
Relationship to business

Email address (optional)

References


Name/business
Relationship
Phone number

First name
Last name
Phone number

Service Address


Street address
City
State
Zip code
Business Location:
Own
Rent
Landlord

Billing Address

Same as Service Address


Street address
City
State
Zip code

What Type of Service(s)

We have many business services not listed here. If you don't see what you want tell us what you need to do and let us make you a solution.

Phone:
None
Flat Rate
Measured Service
 Other

Optional features
Line Hunting
PBX Line
Simple Choice
  Other Features

Internet:
None
Dial-Up
High-Speed (DSL)  We can tell you what speeds are available at your service address when we call.
 Other

TV:
None
Basic TV
Essentials TV Latin Essentials

 Premium Channels

Service Packages:
Office Gold: Phone, Simple Choice, Voice Mail, and High-speed Internet

Comments or Other Products

Before Submitting information please read the Consent for Service

  

We will call you to confirm service and pricing.