Comserv LTD
111 West Second Street
PO Box 310
Schaller, Iowa 51053

Office: (712)-275-4215
Toll Free: (800)-469-9099


 

Comserv LTD REQUEST FOR SERVICE
New Customer or Current Customer Service Address
MOVE
COMP: #333
Name: ____________________________________ Date: ______________
Address _________________________Apt. #______ PO Box: ____________
City: ____________________________________ Zip Code:___________
State: Iowa
Home Phone: _________________________Work Phone.____________________
Contact: ____________________________________

Billing Address: (If Different)
Name: ________________________________________________________
Address ________________________________________________________
City: _________________________State: __________Zip Code:________

Service Information
1. Type of Service ( Circle One)
BASIC HBO/MAX HBO MAX SHOW/MOVIE SHOW MOVIE STARZ/ENCORE

2. Has Cable been in the house before? Yes _______ No _______

If there is more than one outlet, which one do they want to be hooked up to?

_____________________________________________________________

A. If yes - It's a Reconnect - No one will need to be there
B. If no - It's a NEW INSTALLATION - Someone will need to be there
C. Who lived there before? ____________________________________
3. Is your TV Cable Ready? Yes _______ No _______

4. Do you rent or own your home or apartment? _______________________

A. Renters need their Landlord's Consent before we can do a new install.
B. Landlord's Name and Phone Number? __________________________

5. Do you need any additional outlets installed? Yes _______ No _______

A. How many? _______________
B. Someone will need to be home
C. Is outlet on an inside wall, or coming up from the basement or crawl space?

6. Type of Home? Brick_________ Woodsided___________

A. This is only on new installations or additional outlets

7. Date of service desired.___________________________
Mon & Wed: Odebolt Kiron        
Tues & Thur: Galva Cushing        



Disconnect Service: Date desired _________________________________
Fwd. Address: _________________________________
City: _________________________ State:______________ Zip:______________