Telephone Account Sign-up Request Form

Email Address:
Mailing Address:
City, State, Zip:
Physical Address:
PO Box:
City, State, Zip:
Requested Number: 435-528
LD Carrier:
LD Carrier:
(If Other was selected)
Account Type:

Previous Service
Previous Address:
City, State, Zip:
Phone Number:
1st Reference:
City, State, Zip:
2nd Reference:
City, State, Zip:


Note: Should the account be assigned to an outside agency for collection, I/we (the subscriber) agree to pay all attorney fees, with or without suit, court costs, and a collection fee of 50% (fifty percent), which will be added to the outstanding balance of the account.

Bills are due and payable within 10 days of the billing date.

Comments or Questions:
Digital Signature: Date:
  A Gtelco representative will contact you to verify service request information and set an installation time. Gtelco requires that each customer provides a signed Telephone Account Sign-up form and pay a $100.00 deposit and $40.00 setup fee before service is installed. If you sign up for service via the Internet, please come to the Gunnison Telephone office at 29 South Main, Gunnison UT 84634 to pay the fee and sign the form.