Application for Telephone Service Lakeland Communications - Luck & Milltown Telephone Companies Please provide the following information for the  Cushing (648) & Luck (472) Exchanges. Applicant Name    Co-Applicant Name    Billing Address    City  State  Zip Code  Property Address    City  State  Zip Code  Applicant Social Security No.    Applicant Driver's License   Co-Applicant Social Security No.    Co-Applicant Driver's License   Applicant Employer & Address    Co-Applicant Employer & Address    Contact Telephone Number    Publish in Directory As    Additional Directory Name ($2.00/month)    Unlisted (Not in directory but available through directory assitance - $1.00/month)    Unpublished (Not in directory or directory assistance - $2.00/month)    Interstate Long Distance Carrier   Intrastate Long Distance Carrier  Optional Calling Services (Please Check) If you have any questions about what each service is, click on it! Touch Tone Service ($1.25/month)  Call Hold ($2.00/month)  Call Waiting ($2.00/month)   Cancel Call Waiting ($2.00/month)  3-Way Calling ($2.00/month)  Speed Dial 8 ($2.00/month)  Speed Dial 30 ($2.00/month)  Caller ID ($4.00/month)  Call Forwarding ($2.00/month)  Call Return ($2.00/month)  Call Fwd No Answer ($2.00/month)  Call Fwd Busy ($2.00/month)  Call Fwd Remote Act ($2.00/month)  Call Transfer ($2.00/month)   Call Screening ($2.00/month)  Call Trace ($4.00/month)   Priority Ringing ($2.00/month)  Pref Call Forward ($2.00/month)  Voice Mail Res Basic ($3.00/month)  Voice Mail Res. Enh ($5.00/month)  Voice Mail Bus Basic ($5.00/month)  Voice Mail Bus Enh ($7.00/month)  Do Not Disturb w/Pin ($2.00/month)  Repeat Dialing ($2.00/month)  Selective Call Accept ($2.00/month)  Warm Line ($2.00/month)  Voice/Data Protection ($2.00/month)  Code Restriction ($2.00/month)  Personal Ringing ($2.00/month)    Long Distance Calling Restrictions (Please Check) (No charge for these restrictions)   900 Call Blocking  Collect Call Blocking  Third Party Call Blocking  Extended Community Only  Long Distance Blocking    Prepayment Required   New Service which requires a new access line or connection: $120.00 advance payment. New Service to an existing residence with existing access line:$70.00 advance payment. A deposit may be required if you are unable to provide previous telephone history or have a poor telephone credit history. Please mail your advance payment to: Lakeland Communications, Attn. Diane Nelson P.O. Box 300 Luck, WI  54853 We will contact you if further information is required.    I/We request telephone service from Lakeland Communications subject to all rules and regulations under which it operates.  I am 18 years of age or older.  I am aware that the Telephone Company will notify the Polk County Department of Health/Social Services at least 5 days prior to scheduled disconnection of telephone service for any reason, if we requested to do so in writing by the subscriber or other responsible person. Account Holder E-Mail Address  Preferred Date of Connection  Special Instructions   ...     ...    Homepage    New Service Online