Service Application & Order Form | United & Turtle Mountain Communications

Order & Service Application Form

To apply for and order your services from United and Turtle Mountain Communications, please complete the following form.

Step 1 of 6

Are you a new customer?*
- Yes
- No

Business Name
Federal ID Number
Name*
First Last
Email*
Enter Email Confirm Email
Phone Number
Date of Birth*
Month
Day
YYYY
Do you live on Tribal lands?
- Yes
- No
Do you have a Tribal ID?
- Yes
- No
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
911 Address
Same as mailing address

Street Address Address Line 2 City State ZIP Code
CPNI Password*
A 4-digit security password for your account.
Housing Information*
- Own Home
- Rent Home
Landlord
Landlord Phone Number
Prior Resident
Prior Resident Phone
Employer*
Employer Phone
Nearest Relative*
First Last
Nearest Relative Phone*
Joint Application Information
Name
First Last
Date of Birth
Month
Day
Year

Consent Agreement*
I Agree
I (“Customer”) understand that if service is disconnected and reconnected for any reason, reconnect charges will apply. I also understand UTMA & TMC’s equipment will be returned immediately upon termination of service. I agree to be bound by UTMA & TMC’s Terms & Conditions (“T&C”) as published on www.utma.com. My continued use of the service shall be considered my consent to any amendments that may be made to the T&C. I understand that surge and firewall protection are my responsibility, and I agree that I will be responsible for any and all damages or losses. I understand that the router provided in Managed Wireless service and the Managed Wireless Extender equipment are the property of UC and TMC, and I will be charged $225 for the router and an additional $105 for the Managed Wireless Extender if services are disconnected and the equipment is not returned in good working condition. I understand that set-top boxes are the property of UC and TMC, and are due back upon disconnection of services. If not returned, fees will be applied. Long Distance - I grant UTMA/TMC authority to change my long-distance provider as needed to provide service in the bundle selected above. It has been explained to me and I understand that the package price listed on this application and in all other UTMA & TMC materials does not include mandatory fees and taxes. I understand my bill will be larger than the package price due to these charges.
Date
Signature
Phone
This field is for validation purposes and should be left unchanged.

HOT DEAL ALERT! SAVE UP TO $500

To apply for and order your services from United and Turtle Mountain Communications, please complete the following form.

Step 1 of 6

Joint Application Information

Advance payment will be directly applied to your account to help cover installation costs. This is not a deposit.

Internet, Television, & Phone - $305

Internet & Television - $270

Internet & Phone - $155

Internet - $120

Phone & Television - $185

Phone - $35

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