Service AgreementService Agreement • December 3rd, 2024 • Iowa
Sign and complete this form to authorize Searsboro Telephone to charge ACH payment listed below. Monthly payments will be deducted on 15th of the month.
Service AgreementService Agreement • December 3rd, 2024 • Iowa
ACCOUNT NAME: (PARTY RESPONSIBLE FOR PAYMENT) AUTHORIZED PERSON (S) ALLOWED ACCESS TO ACCOUNT STREET ADDRESS: AUTHENTICATION QUESTION: Answer only one question WHAT IS YOUR MOTHER’S MAIDEN NAME? WHAT IS YOUR FAVORITE COLOR? _ WHAT CITY WERE YOU BORN IN? WHAT WAS THE STREET YOU GREW UP ON? MAILING ADDRESS: CHECK IF SAME AS ABOVE CITY STATE ZIP EMAIL ADDRESS PAPERLESS STATEMENT YES NO PHONE NUMBER: CELL CELL PROVIDER RACIAL/ETHIC GROUP (USDA REQUIREMENTThe following information is requested by the Federal Government for certain types of loans and grants, in order to monitor compliance with civil rights laws. You are not required to furnish this information, but are encouraged to do so. The law requires that a program recipient may neither discriminate on the basis of this information nor on whether you choose to furnish it. However, if you choose not to furnish it, under federal regulations, this program representative is required to note race/ethnicity on the basis of visual observation