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First Name Last Name Business Name Address Cell Phone Home Phone Email MCEPA ACCT NBR Contact You Internet Option Phone Sign Up Phone Line Existing Phone Bank Draft AGREEMENT Request Date Time
Kim Holcomb Cason Baptist Church 30018 Cason Rd
Nettleton, Mississippi 38858
United States
(662) 257-5914 6622569687 casonbaptist@gmail.com Email, Phone Cell MEGA-PULSE 100 Mbps - $85.00 Yes, No Keep my existing Phone Number First Phone Line - $34.95 6622569687 I AGREE TO RECEIVE AN E-BILL STATEMENT (VIA THE SAME EMAIL ADDRESS IN THIS FORM) AND NOT A PAPER BILL. I AGREE TO NOTIFY M-PULSE FIBER IF ANYONE IN THE RESIDENCE IS DIAGNOSED WITH COVID-19., I CONFIRM I AM THE OWNER OF THE PROPERTY WHERE SERVICE IS BEING REQUESTED OR HAVE THE PERMISSION FROM THE PROPERTY OWNER., I HAVE RECEIVED A COPY AND AGREE TO THE SERVICE APPLICATION/AGREEMENT WITH GENERAL TERMS AND CONDITIONS. October 16, 2020 at 12:11 pm
Chad Hill D.T.D Outdoors 30492 central grove road
Aberdeen, Mississippi 39730
United States
6626402802 hillchadwick@yahoo.com Text Message, Email, Phone Cell MEGA-PULSE 100 Mbps - $85.00 No Keep my existing Phone Number 662-640-2802 I AGREE TO RECEIVE AN E-BILL STATEMENT (VIA THE SAME EMAIL ADDRESS IN THIS FORM) AND NOT A PAPER BILL., I AGREE TO SIGN UP FOR AUTOPAY USING BANK DRAFT. (SEE ATTACHED FORM) I AGREE TO NOTIFY M-PULSE FIBER IF ANYONE IN THE RESIDENCE IS DIAGNOSED WITH COVID-19., I CONFIRM I AM THE OWNER OF THE PROPERTY WHERE SERVICE IS BEING REQUESTED OR HAVE THE PERMISSION FROM THE PROPERTY OWNER., I HAVE RECEIVED A COPY AND AGREE TO THE SERVICE APPLICATION/AGREEMENT WITH GENERAL TERMS AND CONDITIONS. October 21, 2020 at 9:01 am
Pamela Wigginton Bigbee Baptist Church 30076 New Road
Amory, Mississippi 38821
United States
662-315-1420 662-651-4641 pwiggie47@yahoo.com 1821-003 Text Message, Email, Phone Cell MEGA-PULSE 100 Mbps - $85.00 Yes Keep my existing Phone Number First Phone Line - $34.95 662-256-4096 I AGREE TO RECEIVE AN E-BILL STATEMENT (VIA THE SAME EMAIL ADDRESS IN THIS FORM) AND NOT A PAPER BILL., I WOULD LIKE TO SIGN UP FOR AUTOMATIC BANK DRAFT FOR M-PULSE FIBER USING THE SAME BANK ACCOUNT INFORMATION ALREADY BEING USED FOR MONROE COUNTY ELECTRIC POWER ASSOCIATION., I AGREE TO SIGN UP FOR AUTOPAY USING BANK DRAFT. (SEE ATTACHED FORM) I AGREE TO NOTIFY M-PULSE FIBER IF ANYONE IN THE RESIDENCE IS DIAGNOSED WITH COVID-19., I CONFIRM I AM THE OWNER OF THE PROPERTY WHERE SERVICE IS BEING REQUESTED OR HAVE THE PERMISSION FROM THE PROPERTY OWNER., I HAVE RECEIVED A COPY AND AGREE TO THE SERVICE APPLICATION/AGREEMENT WITH GENERAL TERMS AND CONDITIONS. December 2, 2020 at 3:42 pm
Jody Box Country Garage 30312 hwy 371
Amory, Mississippi 38821
United States
6622564074 Tjkbox93@yahoo.com Text Message, Phone Cell MEGA-PULSE 100 Mbps - $85.00 I AGREE TO RECEIVE AN E-BILL STATEMENT (VIA THE SAME EMAIL ADDRESS IN THIS FORM) AND NOT A PAPER BILL., I WOULD LIKE TO SIGN UP FOR AUTOMATIC BANK DRAFT FOR M-PULSE FIBER USING THE SAME BANK ACCOUNT INFORMATION ALREADY BEING USED FOR MONROE COUNTY ELECTRIC POWER ASSOCIATION., I AGREE TO SIGN UP FOR AUTOPAY USING BANK DRAFT. (SEE ATTACHED FORM) I AGREE TO NOTIFY M-PULSE FIBER IF ANYONE IN THE RESIDENCE IS DIAGNOSED WITH COVID-19., I CONFIRM I AM THE OWNER OF THE PROPERTY WHERE SERVICE IS BEING REQUESTED OR HAVE THE PERMISSION FROM THE PROPERTY OWNER., I HAVE RECEIVED A COPY AND AGREE TO THE SERVICE APPLICATION/AGREEMENT WITH GENERAL TERMS AND CONDITIONS. December 31, 2020 at 2:30 am
doug taylor amory auction 61072 hwy 278e
Amory, Mississippi 38821
United States
16623151625 dougtaylor1986@yahoo.com Phone Cell MEGA-PULSE 100 Mbps - $85.00 No I AGREE TO RECEIVE AN E-BILL STATEMENT (VIA THE SAME EMAIL ADDRESS IN THIS FORM) AND NOT A PAPER BILL. I AGREE TO NOTIFY M-PULSE FIBER IF ANYONE IN THE RESIDENCE IS DIAGNOSED WITH COVID-19., I CONFIRM I AM THE OWNER OF THE PROPERTY WHERE SERVICE IS BEING REQUESTED OR HAVE THE PERMISSION FROM THE PROPERTY OWNER., I HAVE RECEIVED A COPY AND AGREE TO THE SERVICE APPLICATION/AGREEMENT WITH GENERAL TERMS AND CONDITIONS. January 19, 2021 at 8:29 pm
TERESA TAYLOR TAYLOR BODY SHOP, INC. 50391 S. HARMONY RD.
AMORY, Mississippi 38821
United States
662-315-9569 662-256-9569 taylorjt@bellsouth.net Text Message, Email, Phone Cell MEGA-PULSE 100 Mbps - $85.00 I WOULD LIKE TO SIGN UP FOR AUTOMATIC BANK DRAFT FOR M-PULSE FIBER USING THE SAME BANK ACCOUNT INFORMATION ALREADY BEING USED FOR MONROE COUNTY ELECTRIC POWER ASSOCIATION. I AGREE TO NOTIFY M-PULSE FIBER IF ANYONE IN THE RESIDENCE IS DIAGNOSED WITH COVID-19., I CONFIRM I AM THE OWNER OF THE PROPERTY WHERE SERVICE IS BEING REQUESTED OR HAVE THE PERMISSION FROM THE PROPERTY OWNER., I HAVE RECEIVED A COPY AND AGREE TO THE SERVICE APPLICATION/AGREEMENT WITH GENERAL TERMS AND CONDITIONS. January 21, 2021 at 9:02 am
Cindy Loden Todd Construction 30344 Bigbee Rd
Amory, MS 38821
United States
16623158852 6622565252 CLODEN60@YAHOO.COM Text Message, Email, Phone Cell MEGA-PULSE 100 Mbps - $85.00 No I AGREE TO RECEIVE AN E-BILL STATEMENT (VIA THE SAME EMAIL ADDRESS IN THIS FORM) AND NOT A PAPER BILL. I AGREE TO NOTIFY M-PULSE FIBER IF ANYONE IN THE RESIDENCE IS DIAGNOSED WITH COVID-19., I CONFIRM I AM THE OWNER OF THE PROPERTY WHERE SERVICE IS BEING REQUESTED OR HAVE THE PERMISSION FROM THE PROPERTY OWNER., I HAVE RECEIVED A COPY AND AGREE TO THE SERVICE APPLICATION/AGREEMENT WITH GENERAL TERMS AND CONDITIONS. January 21, 2021 at 4:03 pm
kim burt cason water 30007 cason road
NETTLETON, MS 38858
United States
6622562442 casonwater@att.net Email MEGA-PULSE 100 Mbps - $85.00 Yes Keep my existing Phone Number First Phone Line - $34.95, 6622562406 6622562442 I AGREE TO RECEIVE AN E-BILL STATEMENT (VIA THE SAME EMAIL ADDRESS IN THIS FORM) AND NOT A PAPER BILL., I WOULD LIKE TO SIGN UP FOR AUTOMATIC BANK DRAFT FOR M-PULSE FIBER USING THE SAME BANK ACCOUNT INFORMATION ALREADY BEING USED FOR MONROE COUNTY ELECTRIC POWER ASSOCIATION. I AGREE TO NOTIFY M-PULSE FIBER IF ANYONE IN THE RESIDENCE IS DIAGNOSED WITH COVID-19., I CONFIRM I AM THE OWNER OF THE PROPERTY WHERE SERVICE IS BEING REQUESTED OR HAVE THE PERMISSION FROM THE PROPERTY OWNER., I HAVE RECEIVED A COPY AND AGREE TO THE SERVICE APPLICATION/AGREEMENT WITH GENERAL TERMS AND CONDITIONS. January 22, 2021 at 2:33 pm
Kimberly & Timothy Parks K & T Marketing, LLC 30050 Baker Road
Nettleton, MS 38858
United States
6628719895 kimhelpingyou@gmail.com Text Message, Email, Phone Cell MEGA-PULSE 100 Mbps - $85.00 No 662-871-9895 I AGREE TO RECEIVE AN E-BILL STATEMENT (VIA THE SAME EMAIL ADDRESS IN THIS FORM) AND NOT A PAPER BILL. I AGREE TO NOTIFY M-PULSE FIBER IF ANYONE IN THE RESIDENCE IS DIAGNOSED WITH COVID-19., I CONFIRM I AM THE OWNER OF THE PROPERTY WHERE SERVICE IS BEING REQUESTED OR HAVE THE PERMISSION FROM THE PROPERTY OWNER., I HAVE RECEIVED A COPY AND AGREE TO THE SERVICE APPLICATION/AGREEMENT WITH GENERAL TERMS AND CONDITIONS. February 22, 2021 at 12:00 pm

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