MoKan Dial, Inc.

New Missouri Residential Application

The application can be completed on-line below, or you can choose to print the form here, complete and mail or deliver to the business office.

BASIC LOCAL SERVICE PER LINE PER MONTH $13.43 Local Service $5.25, Cass Co. 911 Surcharge $ .79, Interstate Access $ 6.50, Federal Universal Service Charge (FUSC) $.74, Missouri Relay ( Hearing Impairment surcharge) $.13. (Touch-tone - additional 65 cents), MUSF charge .29% of Intrastate Revenue

Required Fields are Marked with an *.

Date: *Installation Date:
*Contact Phone:
*Applicant's Name:
*Spouse: *Service Address: *Billing Address:

Publish in directory
List As::
Additiona Listing ($.50/month):
*ID# (SSN or Drivers License):
*Date of Birth:

*Residence Status
Landlord Name and Number(if applicable):
*Employer: *Employer Address: *Nearest Relative: *Nearest Relative Address: *Previous Phone: *Previous Address:

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):

Metropolitan Calling Area(MCA) $32.50 per month (allows toll free calling to the Metro Kansas City area:
No Yes

Please select Calling Features (charges are monthly.) Features marked with "**" are available in groups of 2 or more at reduced one time charge of $6.35 to add features: 900 Call Block ($0.00) Collect Block($0.00)
Bill to 3rd No. ($0.00) Call Waiting ($1.00)** Call Forwarding($1.00)** 3 Way Calling ($1.00)** Cancel Call Waiting($1.00)** Speed Dial 8 ($1.00)** Call Forward Busy ($2.00) CFW No Answer ($2.00) Caller ID($6.95)
Automatic Call Back ($3.00) Speed Call 30 ($2.00)
Toll Denial ($1.00)** Automatic Recall ($3.00)
Anonymous Call Rejection ($3.00) Selective Call Acceptance($3.00) Selective Call Forwarding($3.00) Selective Call Rejection($3.00) Line Hunt ($2.50) Customer Originated Trace ($5.25)

*Please choose a long distance carrier from the list below for INTERLATA calls.

*Please choose a long distance carrier from the list below for INTRALATA calls.

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**

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 Freeman Customers this would be calls to 913, 816, or 660 area codes. 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.

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.

By clicking the submit button I understand and agree to the following statement: The undersigned makes application for the above service and agrees to pay established rates for such service. In making this application the Undersigned agrees to the rules and regulations of MoKan Dial, Inc. as set forth in the Exchange Tariff and in any changes in the rules, 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 on the submit button I agree and accept the above statement.