Mokan Dial, Inc.

New Kansas Residential Application

The application can be completed on-line below, or a printable version can be located to the right. Please feel free to complete, mail or deliver to the business office.

Basic Local Service Per Line Per Month $21.71 (City) and $21.10 (Rural) Local Service $12.10, 911 Surcharge $ .75, Interstate Access $ 6.50, Kansas Universal Service Fund (KUSF) $1.01 Federal Universal Service Charge (FUSC) $0.74 City Franchise Tax (within the City Limits) $.61

Fields marked with * are required.

Date: *Installation Date:
*Contact Phone:
*Applicants Name: *Spouse Name: *Service Address: *Billing Address: *ID (SSN, D.L, or DOB):
*Employer: *Employer Address: *Nearest Relative:
*Nearest Relative Address:
*Previous Phone: *Previous Address:

Publish in directory (unlisted $2.00 month)
List As:

Additional Listing ($1.35 per month)

*Residence Status
*Landlord Name and Number(if applicable):

*Inside Wire Maintenance Program ($1.95/month)

Customer Proprietary Network Information (CPNI) CPNI Password:

Favorite Color:

City you we're born in:
Additional Authorized Contact

Bundled Services are now available. For a detailed list of each package, click here. Bundled services rates do NOT include taxes and surcharges. (End User line charge, 911, City Franchise, FUSC, KUSF, etc.) Any bundles including MKS Extreme DSL requires additional DSL service application.

*Please select a Bundle Service (charges are monthly):

Please select Calling Features (charges are monthly): These are the most common/requested calling features. Other services may be available.
900 Call Block ($0.00) Collect Block($0.00)
Bill to 3rd No. ($0.00) Call Waiting ($1.50) Call Forwarding($1.50) 3 Way Calling ($1.50) Cancel Call Waiting($1.50) Teen Line ($1.50) Speed Call 8 ($1.50) Speed Call 30 ($3.00) Call Forward Busy ($3.00) CFW No Answer ($3.00) Automatic Call Back ($3.00) Caller ID($7.50)

Directory Assistance (411) is available to all customers of Mokan Dial, Inc. $1.00 per call, 2 listings per call. Call completion is available for an additional per minute rate.

We offer pre-paid and regular calling cards. Prepaid cards are available for under $.04 per minute. Regular cards are $.20 per minute plus a $.50 per connect charge.

Internet Service is provided to customers of Mokan Dial, Inc. through MoKan Communications, Inc. Dial-up Service is available to all customers of MoKan Dial, Inc. High Speed (DSL) is available to most customers limited by distance from Serving Wire Center Equipment. A seperate application is required for Internet Service Dial up or DSL. No length of service required for Dial-Up. Service charges to activate DSL are waived if a one year contract is signed. All necessary forms can be found at our menu to the right, or at the Mokan Communications website.

Please choose a long distance carrier from the list below for INTERLATA calls. Mokan Dial, Inc. offers Block of Time plans, flat rate plans, and Unlimited Long Distance plans. To take advantage of these plans you must choose MoKan Communications from the list below. For questions, please contact the appropriate long distance carrier. Contact information can be found to the right under "Additional Kansas Information".

Please choose a long distance carrier from the list below for INTRALATA calls. Mokan Dial, Inc. offers Block of Time plans, flat rate plans, and Unlimited Long Distance plans. To take advantage of these plans you must choose MoKan Communications from the list below. For questions, please contact the appropriate long distance carrier. Contact information can be found to the right under "Additional Kansas Information"

If you have selected MoKan as your Long Distance carrier, please select from one of the following calling plans

Please Choose One Option

Block of Time Plans**
$4.00/One hour and $.08 per additional minute
$40.00/25 Hours and $.08 per additional minute
$25.00/15 Hours and $.08 per additional minute

Flat Rated Plans
$5.95 Monthly Fee $.05 per minute
$3.95 Monthly Fee $.10 per minute
No Monthly Fee, $.15 per minute

***Block of Time Plans are for “Intralata” direct dialed calls. For Hillsdale & Louisburg customers this would be calls to 913, 816, or 660 area codes. Rantoul customers Intralata calls are to the 785 area code. Calls to Internet Service Providers do not qualify for discount. Flat rated Plans are calls anytime within the 48 contiguous United States. Calls to Internet Service Providers do not qualify for discount

If your current long distance carrier does not appear on the above list, please contact them for service. It is the responsibility of each individual to notify the carrier of choice to initiate service.
YES, I want Preferred Carrier Freeze activated.
A preferred carrier freeze means that the Carrier you have designated for Interlata and Intralata will NOT be changed by MoKan Dial, Inc. unless you request that the Freeze be lifted. This request to release the Freeze must come from the customer and may be written or oral. If an oral request is made the telephone company will require either date of birth or Social Security number for verification. Any carrier changes (PIC) received by the telephone company will be rejected unless the Freeze is released.

By clicking "submit" the undersigned makes application for the above services and agrees to pay established rates for such service. In making this application the undersigned agrees to the rules and regulations, tariffs or rates for the service furnished under this application. The undersigned also understands if additional lines are added in the future, and if one line is disconnected for payment purposes, the other lines may also be suspended. The undersigned is responsible for any and all long distance charges made from or charged to this account. Monthly rates listed above do not include sales tax.

By clicking the "submit" button I agree that I have read the statement directly above.