Prompt Payment Contract/Automatic Payment Please choose if you wish you pay your bill each month (Prompt Payment) or if you prefer having it taken out of your bank account (Automatic Payment). Name(s) On AccountContact Number:*Physical Address:* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mailing Address:* Mailing Address is the Same Mailing Address is Different Mailing Address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Collection Policy:*BILLING: Statements will be mailed to the subscriber within the first week of the month. Monthly charges will be billed one month in advance. Failure to receive a bill does not relieve the subscriber of the responsibility for payment. Employees are not allowed to accept payments outside the business office. – LATE PAYMENT: In the event that payment is not received in full by 12 noon on the 20th day of the same month in which service is rendered, a late charge of $20.00 will be assessed. A reminder notice will be mailed to the subscriber. – NON-PAYMENT: If the delinquent account is not paid in full by 12 noon on the 10th day of the month following the month in which service was rendered, all services will be suspended. For subscribers with dial tone, 911 and 611 (business office) will remain active. When the 10th falls on a Friday or a day the business office is closed, service will be suspended on the following business day. – RESTORAL: Any account that is suspended for non-payment will be assessed a $28.00 restoral fee. Service will be restored during regular business hours after the account balance and restoral fee have been paid in full. – NEW SUBSCRIBER: New subscribers will be required to sign the Prompt Payment Contract. Under the Prompt Payment Contract, payment is due in full by 12 noon on the 15th day of the same month in which service is rendered. Prompt Payment customers will not receive a reminder notice. In the event that payment is not received in full by 12 noon on the 15th day of the same month in which service is rendered, all services will be suspended. When the 15th falls on a Friday or a day the business office is closed, service will be suspended on the following business day. Any account that is suspended for non-payment will be assessed a $28.00 restoral fee. Service will be restored during regular business hours after the account balance and restoral fee have been paid in full. If the suspended account is not paid in full by 12 noon on the 20th day of the same month in which service is rendered, a late charge of $20.00 will be assessed. The Prompt Payment Contract will be in effect for one year. If during the year service is suspended for non-payment, the contract will be extended until a satisfactory credit rating has been established. In lieu of the Prompt Payment Contract, subscribers may elect to enroll in the Automatic Payment Plan. – NON-SUFFICIENT FUNDS: All checks returned for non-sufficient funds will be assessed a $30.00 surcharge, plus any applicable taxes. RECOVERY OF SUBSCRIBER DEBT TO THE COOP: The Company will collect any written off balances from the subscriber’s standard capital credit account. Subscribers will be assessed a 40% discount on their standard capital credit account when used for the recovery of a debt to the coop. I have read TrioTel’s Collection Policy. Prompt Payment Contract or Automatic Payment Plan?* Prompt Payment Contract Automatic Payment Plan Prompt Payment Contract:*I agree to have my account paid in full by 12 noon on the 15th of the month in which service is rendered. I understand that if payment is not received in full by 12 noon on the 15th of the month in which service is rendered, all services will be suspended. When the 15th falls on a Friday or a day the business office is closed, service will be suspended on the following business day. I understand that if my account is suspended for non-payment, a $28.00 restoral fee will be assessed. Service will be restored during regular business hours after the account balance and restoral fee have been paid in full. I understand this agreement will be in effect for one year and if during the year service is suspended for non-payment, the contract will be extended until a satisfactory credit rating has been established. I have read and agree to the terms and conditions of the Prompt Payment Contract. Automatic Payment Plan:*Automatic Payment Plan subscribers will continue to receive a monthly bill. The deduction will occur on the 15th of the month. When the 15th falls on a day the business office is closed, the deduction will occur on the following business day. The Automatic Payment Plan will continue in effect until TrioTel receives notification of termination; subject to the file processing date. Any payment returned for non-sufficient funds will be assessed a $30.00 surcharge, and may result in removal from the Automatic Payment Plan. I authorize TrioTel to initiate entries to my checking/savings account. Name of Bank:*Account Type:* Checking Savings Bank Routing Number (first set of numbers):*Bank Account Number (second set of numbers):*Lifeline is a federal program that lowers the cost of telephone service, bundled telephone-broadband service, and broadband only service that meets minimum standards. Lifeline provides a discount up to $9.25 per month for eligible low-income subscribers and is non-transferable. Customers can qualify for one discount per household if their income is at or below 135% of the federal poverty guidelines or by participation in one of the following programs: Federal Public Housing Assistance (FPHA); Supplemental Nutrition Assistance Program (SNAP)(Food Stamps); Medicaid; Supplemental Security Income (SSI); Veterans Pension or Survivors Pension Benefit. Applicants will be required to provide proof of eligibility and re-certify annually. Toll Blocking service prevents the placement of all long distance calls for which a subscriber would be charged. Toll blocking is available at no cost. Customers can apply for Lifeline by mail or online at CheckLifeline.org. Signature:*Comments:
