Farmington Account Setup Verification
Type of Account
*
Residential home
Business
Name
*
First Name
Last Name
Business Name, if applicable
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Type of residence?
*
Own
Rent
Main Contact Phone Number
*
Please enter a valid phone number.
Is your main contact phone a Land line or Cell line? Please check one
*
Landline
Cell Line
Would you like to enroll in paperless billing?
*
Yes
No
Email
*
example@example.com
Would you like to enroll in text/email alerts/updates?(If yes, enter valid mobile phone or email below)
*
Yes
No
Service Alerts via Text
*
Please enter a valid mobile phone number.
Service Alerts via Email
*
example@example.com
Submit
Should be Empty: