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Please add the following services to my account. I understand I will receive a confirmation e-mail within 72 hours verifying that these services have been added to my account. If I am adding Cable Television or Internet services for the first time, either as a part of a FLAT RATE Package or a la carte, I will be contacted to schedule an installation or to set-up the service. Certain service order and/or installation fees may apply.

FLAT RATE Packages:
Please add, change or switch my services so that I am receiving all of the services in the package I choose below.
Phone + Digital Cable TV + High Speed Internet
The Movie Package I choose is: HBO Showtime/The Movie Channel STARZ!/ Encore Cinemax
Phone + Basic Cable TV + High Speed Internet
Phone + High Speed Internet
Phone + Dial-up Internet
I want to add a block of minutes to my plan:
200 minutes: $19.95 500 minutes: $49.95 1,000 minutes: $99.95
Calling Features:
Caller ID	$3.95/month
Voice Mail	$5.95/month
Call Waiting	$2.50/month
Call Forwarding	$2.50/month
Selective Call Forwarding	$2.50/month
Three-way Calling	$2.50/month
Find me Service	$3.95/month
Terminating Call Manager (blocks Telemarketers)	$1.95/month
Distinctive Ring/Teen Line	$5.00/month
Distinctive Ring Call Waiting	$2.50/month
Automatic Recall (*69)	$2.50/month
Automatic Callback (*66)	$2.50/month
Anonymous Call Rejection	$2.50/month
Selective Call Rejection	$2.50/month
Selective Call Acceptance	$2.50/month
Toll Deny	$5.00/month

Long Distance:
US 10¢ Plan ($3.95/month plan charge applies)
10¢ Within 25 Miles
Simple Savings (14¢ per minute)
North Iowa Plan ($29.95 per month)
I would like a Calling Card
I would like a Toll-free Number ($3.00 per month/$5.95 per month for businesses-- with your first 20 minutes FREE)
By choosing an OmniTel long distance plan above, I authorize OmniTel to handle all my long distance calls. I understand that there will be no charge for making this change. (REQUIRED)

Cable TV:
Digital Cable	$47.95/month
Basic Cable	$36.95/month
Digital Cable + One Movie Package	$59.95/month
Digital Cable + Two Movie Packages	$71.95/month
Digital Cable + All Movie Packages	$87.95/month
HDTV - High Definition	$9.95/month*
Digital Video Recorder (DVR)	$9.95/month*
HDTV and DVR	$14.95/month*
The Movie Package I choose is: HBO Showtime STARZ!/ Encore Cinemax
* only available with Digital Cable Service.

Internet:
High Speed Internet Service	$39.95/month
512K DSL High Speed Internet Service	$49.95/month
768K DSL High Speed Internet Service	$59.95/month
1.5 Mbps DSL High Speed Internet Service	$69.95/month
Accelerated Dial-up Internet with Pop-up Blocker	$24.95/month
Dial-up Internet	$19.95/month
I have viewed and agree to OmniTel's Acceptable Use Policy (REQUIRED) Note: For i wireless Service and/or additional phone lines, please call OmniTel Communications at 749-2531 or 1-877-OMNITEL! I authorize OmniTel Communications to charge my account for the services marked above.
Full Name	Required
Company Name, if applicable (as it appears on your telephone bill):
Current Phone Number(s):	Required
Address (to where your telephone bill is sent):	Required
E-mail address:
Initial:	Required
Date:	Required
The information you submit will not be distributed to any other parties. We appreciate your business!