Home Phone Service

Residential Utility Services from Companies You Can Trust

Service provided by:
TerraCom logo

Lifleine Self Certification / Home Phone Service Order

Service Request
    Account Number: (if given to you by rep over the phone)
1. Type of Service

New Service
Convert my Existing Number

2. Choose a plan (Both plans are free to activate and free service for the first month. $0 to start!)

A. Basic Plan, $1.95/mo, 11 calling features, 400 Minutes Long Distance per month.
B. Unlimited Plan, $6.95/mo, 11 calling Features, Unlimited Long Distance

 
3. Inside Wiring Plus (IWP)

$1.00/mo. Let us maintain your inside wiring.

 
4. Long Distance

Just keep the long distance that comes free with my service.
Block All Long Distance (no charge)
1+ Long Distance ($3 access fee, $0.109 per minute)
Unlimited Long Distance, $20/mo ($3 Access Fee)

 
5 Directory Listing

Published Number (no charge)
Non-Published Number, $8 Set up Fee, then $4.95/mo)

 
6. Toll Restriction

I understand that I can voluntarily elect toll restriction at no charge. I also understand that if I do not choose toll restriction, I am responsible to pay TerraCom for all charges.
I voluntarily elect toll restriction.
I do not wish to have toll restriction

 
Customer Information
First Name * Last Name *
Address *
City   * State * Zip  *
       
Social Security # * (9 numbers, no dashes) (needed for customers receiving Lifeline government assistance)
Date of Birth * (mm/dd/yyyy)  
Current Home Phone (###-###-####) (if Applicable, required on conversions)
Contact Phone # * (###-###-####)  
eMail Address   *Required Fields

Eligibility for Lifeline. Choose all programs you currently participate in.
*Must choose at least one to qualify
Food Stamps / SNAP
Supplemental Security Income (SSI)
Medical Assistance (Medicaid/Sooner Care)
Low Income Home Energy Assistance Plan (LIHEAP)
Tribal Administered TANF
Temporary Assistance to Needy Families (TANF)
Head Start (income qualifying/ residents of Tribal Land Only)
Vocational Rehabilitation (including AID to the hearing impaired)
Oklahoma Sales Tax Relief
National School Lunch Program (Free program only)
Federal Public Housing Assistance(HUD/Section 8)
Bureau of Indian Affairs General Assistance