| First Name | Last Name | Business Name | Address | Cell Phone | Home Phone | 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 | 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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