Keep it Local, Make it Faster

Keep it Local, Make it Faster

Sign up for CTC's current promotional offers
Full Name *

First Name Last Name
Contact Phone Number *

Area Code Phone Number
Which promotion would you like to take advantage of? *

I am a new internet customer and I want to a free device lease for one year and $150 service credit. I want to upgrade my internet service and receive a free device lease for a year!
By completing this form and signing below, I agree that I will keep my new or upgraded CTC services for one full year from the date of service installation or speed upgrade. If I disconnect my new service or downgrade my speed before the one year is up, I agree to pay the remainder of my contract in full as well as the total of credit I received as a result of signing up for service. I also agree to return my leased equipment upon disconnect at any time or I will pay the full price of the equipment.

I understand that these offers are only available to customers or potential customers that are found to be in good standing with the Cooperative.
Signature *

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Please verify that you are human *
Please select your upgrade choice to be continue to the appropriate page. *

New Internet Customer Upgrading Current CTC Internet Plan
Service Application
Personal Information
Name *

First Name Last Name
Mailing Address *

Address Line 1

Address Line 2

City State / Province

Postal / Zip Code
Physical Location of Service Connect *
Current Cell Phone Number *

Area Code Phone Number
Email *
example@example.com
May we use your Email to Contact you? *

Yes No
How would you like to receive your bill? *

By Mail By Email Only By Mail and Email

Date of Birth *

Month Day Year
Date
Social Security Number *
Just the Number with no dashes
Drivers License Number and State of Issuance *
Employer *
Length of Employment *
Occupation *
Employer Contact Number *

Area Code Phone Number
Close Relative *
Close Relative Relationship *
Close Relative Phone Number *

Area Code Phone Number
Close Relative Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Do you own or rent your home? *

Own Rent
If you rent your home, please provide your Landlord's name
Will there be a Co-Applicant, such as a spouse, listed on your account? *

Yes No

Co-Applicant Information
Co-Applicant Name

First Name Last Name
Co-Applicant Email
example@example.com
Co-Applicant Cell Phone

Area Code Phone Number
Co-Applicant Date of Birth

Month Day Year
Date
Co-Applicant Driver's License Number and State of Issuance
Co-Applicant Social Security Number
Just the numbers with no dashes
Co-Applicant Employer
Co-Applicant's Employer Phone Number

Area Code Phone Number
Co-Applicant's Occupation
Co-Applicant Length of Employment

Have you had previous telephone service with CTC? *

Yes No
If so, is there an outstanding balance on that account? *

Yes No
If a Service Call is required, I understand I will be billed at the hourly rate of $72.50/hour for time and materials. *
Please initial to agree
Do you or anyone in your household have any disabilities that may inhibit access to our service offerings? *

Yes No
If you answered yes to the question above, please explain
I declare that the information provided is true, accurate and complete to the best of my knowledge, and is voluntarily submitted for the purpose of receiving telephone service in Cordova.
I hereby agree to pay all service charges, toll charges and monthly charges as set forth in the Cooperative's tariff. I understand that CTC mails the billing for this service between the first and the fifth of every month and that payment must be received in full by the 20th of each month. Failure to pay by this date will result in written notice of past due status and will subject my account to suspension if not paid in ten days. Service, if suspended, will not be restored until full payment plus a $25 reconnect charge is received.
Should I fail to make complete payment for services rendered after disconnection of my service, I understand that CTC will have the right to pursue collection against me. I agree to pay all reasonable costs incurred in the collection process as well as any applicable interest due as set forth in the Cooperative's tariff.
I understand that the deposits required are separate from my monthly billing and that CTC will hold any said deposits until such time as follows:
1. Instrument Deposit: Until instrument is returned.
2. Security Deposit: 60 days following termination of service or upon establishment of two (2) years of continuous good credit with no more than two (2) disconnect notices.
I hereby certify that I am at least eighteen (18) years of age and agree to abide by the bylaws of this Cooperative. I have read the above information and understand that this application for service becomes that property of the Cooperative and is not to be used for any other purpose than in connection with my account.
Signature *

Clear

What type of Service are you looking for? *

Landline and Internet Service Internet Service Only

Member only DSL Service

Please only complete if you wanted DSL service with your Landline
Please choose a DSL Package
Packages are based on speed. Please see table below for Maximum Usage and price per month.

Non-Member DSL Packages

These packages do not include membership to the cooperative.
Please choose a DSL Package
Packages are based on speed. Please see table below for Maximum Usage and price per month.

A VDSL modem is required for all packages. We offer these modem/router combination units for lease or purchase.
Modem Options *

I will purchase a VDSL modem for $159. I will lease a VDSL modem/router combo for $5.60/month. I would like to discuss my options with a Customer Service Representative.
By leasing a modem/router from CTC, I acknowledge I must return the equipment if I disconnect service and if I do not return the equipment within 5 days of disconnect I will be charged the full price of the unit.
Please type initials as agreement of lease policy.
Please choose a Network Name for your Wifi Network *
Please choose a Password for your Wifi Network *
Please choose a login name for your internet connection. *
Please use all lowercase letters.
Please choose a password for your internet connection. *
Must be at least 8 characters, 1 uppercase & 1 number
Signature *

Clear
Please review our Internet Privacy and acceptable Use Policies at your earliest convenience. Sign below to acknowledge it is your obligation to read and follow these policies or your service may be terminated.

CPNI Registraton
In accordance with the Federal Communications Commission's (FCC) customer Propriety Network Information (CPNI) rules, communication companies are required to set up password protection for your account. CPNI is information that communication companies acquire about their subscribers. It includes not only what services are used but the amount and type of usage. CPNI does not include your name, address or phone number.
Name on Account *

First Name Last Name
Cordova Telephone Cooperative and Cordova Wireless Communications are serious about keeping your information safe from pre-texting (someone calling us and pretending to be you). When a customer asks for information on their account, a PIN or Password must be confirmed before information about the account is released. The person's name that appears on the bill is the only person authorized to make inquiries on this account either in person or by phone. If you want to allow someone else to make inquiries on this account, for example your spouse, simply print their name(s) below.
Name 2

First Name Last Name
Name 2

First Name Last Name
Account Password *
Secret Question (Pick One-This will allow CTC to release your password to you or others with the correct answer):
Choose a Question *
Answer *
We are committed to respecting and protecting the privacy of our members. CTC and CWC do not sell or provide customer information to third parties for sales or marketing purposes. For more detailed information, please refer to our privacy policy.
Date *

Month Day Year
Date
Signature *

Clear

Current Customer Upgrade
Are you currently a member of the Cooperatve

Yes I am an active member of the Cooperative with both a landline and internet. No, I am not a member of the Cooperative as I only have internet and I do not have a landline.
I understand that by taking advantage of this promotion I am committed to the upgraded speed for one year and I may not downgrade or discontinue service during that time. If I do discontinue service before the year has expired I will pay the full price of the remaining contract. I will also return the leased equipment within 5 days of cancellation or I will pay the full price of said equipment.
Signature

Clear
A Customer Service Representative will contact you shortly to discuss upgraded speed options. Thank you!
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Keep it Local, Make it Faster

Service Application

Personal Information

Co-Applicant Information

Landline Service

Member only DSL Service

Non-Member DSL Packages

CPNI Registraton

Current Customer Upgrade