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Contact Information
Customer Information

Married Single
Divorced Widowed

Own Rent
Employment Information

Spouse or Co-Responsible Adult
Nearest Relative:

Local Telephone Service
$14.00*($8.00 credit given to Customers who subscribe to more features/services)

*Does not include regulatory charges, taxes, and other surcharges
Directory Listing
Automatic Bank Account Charge Authorization
Choose Desired Options
Published Free (Available from Directory Assistance and Brandenburg Directory)
Non-listed $1.50 Per Month (Available from Directory Assistance, not published in Brandenburg Directory )
Non-published $2.00 Per Month (Not available from Directory Assistance nor Brandenburg Directory)
No (Free)
Yes ($1.95/month phone only or $ 2.95/month phone, Digital Video and/or DSL)
Voice Mail/Call Answer Service
10 minutes $5.00
20 minutes $6.00
30 minutes $7.00
Number of Rings
10 minutes $7.50
20 minutes $8.50
30 minutes $9.50
Number of Rings
10 minutes $10.00
20 minutes $11.00
30 minutes $12.00
Number of Rings
30 minutes $20.00
Number of Rings
Class Services:
(1) Teen Service - $3.95
(2) Automatic Call Back - $4.50
(3) Automatic Recall - $4.50
(4) Calling Number Delivery - $6.50
(5) Dialable Number Delivery - $7.50
(6A) Calling Number/Name Delivery - $7.50
(6B) Dialable Number/Name Delivery - $8.50

(7) Call Block - $3.50
(8) Distinctive Ringing/Call Waiting - $3.50
(9)Selective Call Forwarding - $3.00
(10) Avoid-A-Call - $2.50
(10A) Anonymous Caller Rejection - $1.00

Pick any three;(2), (3), (7), (8), (9) or (10) and save up to $ 3.50 per month - $9.00
Speed Calling 8 - $1.60
Speed Calling 30 - $2.55
Call Waiting - $1.60
Three Way Calling - $1.60
Call Forwarding - $1.60
Brandenburg Telephone Residential Plan ($0.15/minute with no service fee)

Brandenburg Telephone Home Plus Plan ($0.10/minute, $ 3.95 per month)

Other Carrier, please name:

Yes No
It is your responsibility to contact your carrier if choosing a provider other than Brandenburg Telephone Long Distance. These long distance charges may not appear on your local phone bill. We will make every effort to ensure that your telephone service is connected to the Long Distance Company you choose. In the event your service is inadvertently connected to a different company, we will assume liability only to the extent of connecting your chosen company at the earliest opportunity after you notify us.
Digital Video
DV-Basic - (DVB) $17.95

DV-Deluxe - (DVD) $72.95

DV-Gold - $92.85

No Package
DVR - Digital Video Recorder for $12.95
Whole Home Digital Video Recorder $17.95
HD Deluxe - HD Local plus the following channels for $10.95
HD Digital Video Recorder $19.95
Whole Home HD DVR $24.95
Sports Pack - $9.95

Family Pack - $11.95

Movie Channels
Cinemax with More MAX, Action MAX, Thriller MAX, @MAX, W MAX, Outer MAX, and Star MAX Channels. - $17.95

Home Box Office with HBO2, HBO Plus, HBO Signature, HBO Family, HBO Comedy, HBO Zone and HBO Latino Channels. - $20.95

Showtime with Showtime 2, Showtime Beyond, Showtime Extreme, Showtime Showcase, Showtime Next, Showtime Family, Showtime Woman, Movie Channel, Movie Channel Xtra, and FLIX - $19.95

Starz with Starz Edge, Stars Kids & Family, Starz In Black, Starz Cinema, Starz Comedy, Encore, Encore Wam, Encore Action, Encore Love, Encore Mystery, Encore Drama, Encore Westerns - $16.95

Cinemax and HBO Packages - $37.95

Cinemax and Showtime packages - $37.95

HBO and Showtime Packages - $37.95

Cinemax and Starz/Encore - $37.95

HBO and Starz/Encore - $37.95

Showtime and Starz/Encore - $37.95

HBO, Showtime and Starz/Encore - $51.95

Showtime, Starz/Encore, Cinemax - $51.95

HBO, Cinemax, Showtime - $51.95

HBO, Cinemax, Starz - $51.95

All Four Channels - $63.95

No Movie Package
Adult Programming also available upon request. Please contact our office for more details.
Internet Services
Yes, I am interested.
No, I am not interested.

We have broadband internet packages starting at $29.95 with speeds up to 1 Gig in fiber areas. We are currently building fiber to the home to as many residences as possible but at this point fiber is not available in all areas. A service representative will contact you to determine what internet packages are available in your area and will help you decide what package will work best for your internet needs.

Optional Services

Managed Wifi

If left blank, and selecting any internet plan, we will contact you for this information.
Yes No
Your estimated installation charges, 1 month charge on Digital Video and/or DSL and deposit (if required) must be paid prior to installation. Our office will contact you to discuss applicable charges prior to installation.