Carbon & Emery Counties Service Application

Please fill out the following service application and an Emery Telcom representative will be in touch with you in one business day to complete your order. Services available in Hanksville (Utah) only. Prices subject to taxes, government charges and franchise fees.

Currently an Emery Telcom Customer? *

Yes No

Full Name *

First Name Last Name

Phone Number *

- Area Code Phone Number

E-mail

Physical Address for Service *

Street Address
Street Address Line 2
City	State
Zip Code	Country

Billing Address *

Street Address
Street Address Line 2
City	State
Zip Code	Country

Choose at Term *

Deposit (Cost of one month of service) Auto Pay (Credit card or bank account number)

Hanksville Phone & ExStream Internet

See our Hanksvile Web Brochure for additional details.

Hanksville Bundles *

Bundle 1: $60.22/month
Phone | Long Distance | 10 Mb ExStream Internet Bundle 2: $70.22/month
Phone | Long Distance | 20 Mb ExStream Internet A La Carte Phone Service: $17.82/month
Price subject to taxes, government charges, and franchise fees.

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