Add Name (Co-Applicant) Form

I would like to add the following individual to my Lakeland Communications account. I understand this individual will have access to my account including bill statements, inquiry, changes, deletions, and additions to services. The Co-Applicant will become equally responsible for any bills derived by any services attached to this account.

ADD NAME (CO-APPLICANT) FORM

Account #:

Current Account Holders Name

Name of person being added to account

Co-Applicant Date of Birth

Co-Application Telephone Number

Co-Applicant Email Address

For Telephone account only: List in the Directory as:

Printed Name of Account Hoolder

Signature of Account Holder

Clear

Date

Printed name of Co-Applicant

Signature of Co-Applicant

Clear

Date

Note: Lakeland Communications may call your telephone number of record once this form is received to verify the accuracy of this request. From this point forward all bills and correspondence will also be directed to me as the Co-Applicant.

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