Please fill out this form with your DISCONNECT AND RECONNECT DATES.

• Notice of vacation/seasonal disconnect must be submitted yearly in writing.
• Reconnect date is required. If reconnect date falls on a weekend or holiday, service will be reconnected the prior business day.
• Seasonal disconnect is six months maximum or fees will apply - if the request is longer than 6 months a minimum of $10 per month plus equipment fees will apply on the bill.
• There will be a $50.00 reconnect fee charged when services are reconnected.
• Phone must be reconnected within 6 months to keep phone service active.
• Crosslake Long Distance and Onvoy customers will be charged an additional $3.95 per month.
• Rates subject to change based on FCC Subscriber Line Charge
• During your disconnected months, you will be able to dial 911 or 611 (Crosslake Communications)

First Name *

Last Name *

Service Address *

Billing Street Address

Billing City

Billing State

Billing Zip

Email *

Phone *

Account Number

(Please only put your account number in this field. Comments go below in the comments field.)

Comments?

Please check the service(s) you would like to disconnect

Telephone - $4.75/month plus taxes *

Disconnect

No Disconnection Needed

Telephone disconnect date requested:
Please choose the YEAR and MONTH you want service disconnected and reconnected. *

Telephone reconnect date requested: *

Cable TV *

Disconnect

No Disconnection Needed

Cable TV disconnect date requested:
Please choose the YEAR and MONTH you want service disconnected and reconnected. *

Cable TV reconnect date requested: *

Internet *

Disconnect

No Disconnection Needed

Internet disconnect date requested:
Please choose the YEAR and MONTH you want service disconnected and reconnected. *

Internet reconnect date requested: *

Winter Rate Internet plan to keep your cameras and thermostat on while you are away. Internet speed 1meg down/5meg up which is adequate for your security devices. Maximum Winter Rate is 6 consecutive months during a 12-month period. $34.95/month

Yes, I will take Winter Rate Internet

No, I do not want Winter Rate Internet

Winter Rate Start Date

Winter Rate End Date

Keep crosslake.net E-mail active ($5.95/month per E-mail address)

Yes

N/A

Terms of Acceptance and Signature

Please type your First and Last Name *

Date

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance. If my dates are past the six months maximum, I understand and agree to pay the fees that will be applied to my bill.

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Crosslake Seasonal Disconnect

CrossLake Seasonal Disconnect

Terms of Acceptance and Signature