NTCNET- Direct Fiber Residential Package Application

Residential Fiber Application Form
Please enter your name(s):*

Service Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different from Service Address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*
Please enter a valid phone number.
Cell Phone (if applicable)
Please enter a valid phone number.
Email
example@example.com
Preferred Method of Contact:

Home PhoneCell Phone

Driver's License Number (Optional):
To speed up the process, please upload a photo copy of your license for our records.

Cancelof
Are you an existing NTCNET Customer?

YesNo
Is your current service Aerial or Buried?

AerialBuriedNot sure

Would you like to use the NTCNET Provided Router or setup and configure your own router using PPPoE?

NTCNET Provided RouterUse My Own Router
Note: You will have the option to choose your own custom Wi-Fi Name and Password when the Customer Service Representative reaches out to continue the Fiber Installation process. Minimum of eight characters for the password and limited to special characters- "!, ?, @, #, *".
Do you have any areas where Wi-Fi coverage is weak and needs improvement?

YesNo
Are you interested in learning more about NTCNET's Extender Solution for any areas that need improvement?

YesNo
Router Make/Model

Notices
Attention All New Customers:
All bills are rendered the first of each month and are due upon receipt. Payment within ten days is requested. Payments are due by the 23rd of each month; after that date, unpaid accounts are considered delinquent. Please bring or send the payment page from your bill when payment is made. All bills stand correct and will not be adjusted after the tenth of the month of the bill. Applicants are subject to approval and will be notified if a deposit is required.
All New Telephone Subscribers:
Per CC Docket 91-115, we are required to notify you of the following FCC regulations. Whenever you accept a third party number or collect call, we are required to release your billing name and address (BNA) information to the Interexchange Carrier (IXC) that handles the call. This information is necessary to enable the IXC to bill you for the call, should it not be billed on your NTCNET bill. According to the FCC regulations, IXC's can use your BNA information for several reasons other than billing, which include verification for pre-subscription and new address purposes, fraud prevention, and similar non-marketing purposes.
NONPUBLISHED Phone Customers ONLY:
As a non-published customer, your number does not appear in our telephone directory, in directory assistance, etc., nor do we release it if we receive a request. Regarding the above FCC regulations, you have a choice as to whether you want to have your BNA released in the above described circumstances. However, should you choose not to allow BNA release, you may not be able to make third party number calls or receive collect calls on your telephone number. Initial below if you wish to restrict BNA release. Otherwise, we are required by the FCC to release your BNA information to requesting IXC's.

AS A NONPUBLISHED CUSTOMER, I hereby request that, under no circumstances, is my Billing Name and Address (BNA) to be released. I understand that I may not be able to make third party number calls and may not be able to receive collect calls on my telephone number.
(Optional) Do Not allow my BNA to be released:
Initials
For the Protection of YOUR Privacy:

YOU MUST PROVIDE US WITH THE CURRENT BILL STATEMENT

If you do not have your bill statement with you we CANNOT share any customer information NOT EVEN THE AMOUNT OF THE BILL WITHOUT YOUR IDENTITY BEING AUTHENTICATED.

You then will be asked to provide us with a valid Government issued photo ID that matches the name on the account. If you do not have this and have misplaced your bill statement we will be happy to mail you another copy to the billing address we have or call you at the number of record. We will be glad to accept any payment towards your account in any amount you choose but we CANNOT share any account information without proper ID or the bill statement.

We apologize for any inconvenience this may cause. Federal CPNI Laws dictates these safeguards to protect your privacy and the information contained on your monthly bill.

Please consider ONE of the following CPNI Security Questions, as we will require one from you when we contact you. (All parties on the account must know the answer.)
1) What is your favorite childhood friend's name?

2) What is your favorite place you visited as a child?

3) What is your favorite stuffed animal?

4) What is your favorite candy?

5) What is your favorite color?

6) What is your favorite holiday?

7) What is your favorite soft drink?

Any special requests or notes?
I understand that the installation fee is refundable only if I am unable to receive a FTTH signal. Any prepayments for installation are not refundable if I choose to cancel the service or installation after work has been completed. I understand there may be a one-time charge if my inside wire or Ethernet wire is moved to a new location for installation. Bandwidth Caps may apply due to excessive abuse. Please see the NTCNet Acceptable Use Policy and Terms and Conditions on our website. By signing this form I agree to authorize a credit check, all terms, conditions and acceptable use policies set forth by NTCNet.
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Residential Fiber Application Form

Notices

Please consider ONE of the following CPNI Security Questions, as we will require one from you when we contact you. (All parties on the account must know the answer.)