The Peetz Co-op Telephone Company
Voice Mail Department
P.O. Box 155
Peetz Co. 80747
970-334-2220

Application for service

Name. Last____________________________ First______________________.

Address. Street __________________________________________________.

City___________________________________________________.

State____________________   Zip Code_____________________.


Billing Address. Street or P.O. box#___________________________________

City_______________________________________________.
.
State______________  Zip Code_______________________.

Phone num. (______) _____________________

Voice Mail num(_____)____________________

Employment Information

Employers name.________________________________________________.

Address Street_________________________________________________.

City________________________________________________.

State_____________________ Zip Code__________________.

Phone num (______) ______________________.

Year’s Employed_________________________.

Type of Service Requested. Residence.___ or Business ___

Date. Installed.____________________________.
 

Signature:_____________________________________________  Date:_______________________