In order to subscribe to a Surry Telephone bundle plan, you must subscribe to Surry Local and Long Distance if you are not currently a Surry customer.

Yes, I understand by agreeing to this form, I authorize Surry Telephone Membership Corp. to switch my long distance service (Inter-LATA) and local (Intra-LATA) service to Surry Long Distance for the numbers listed. I understand that I may select a different carrier for Inter-LATA and Intra-LATA service.

I understand that my application may be subject to credit review. Surry may use any information obtained through this service application or from and credit reporting agencies. I futher understand that Surry may reject this application for any reason.

I understand that I may be assessed a fee to switch my primary carrier and that by submitting this form the fee will be paid one time by Surry Long Distance.