Password, Back-Up Question and Email/Text Delivery Authorization Form

Password, Back-Up Question and Email/Text Delivery Authorization Form
Customer Proprietary Network Information (CPNI) rules were enacted by the Federal Communications Commission (FCC) to prevent unauthorized disclosure of customers' records.

Please complete the applicable section(s) below.
Password & Back-Up Question

I would like to create a password and back-up question for easy account access from anywhere.

The password needs to be at least six(6) characters in length, with a combination of letters and numbers.

Please note that the password cannot contain biographical information.

Please enter password below.
Password*
Back-Up Question (please answer ONLY one)
What is your Favorite Color?
What is your Favorite Movie?
What is your Favorite Flower?
What was your First Pet's Name?
Email/Text Authorization

I would like to provide an email address and/or cellular number for electronic delivery of account information and required notifications. Please provide the email address that you use for emails (this does not have to be the Heart of Iowa email address that was established when signing up for service).

Please note delivery method will not begin until the email address has been on file for at least 30 days.
Email Address*
Cellular Phone Number*
Please enter a valid phone number.
Date of Birth- Primary*

MonthDayYear
Date
Date of Birth- Secondary

MonthDayYear
Date
By signing below, I confirm that I am the account holder and grant permission for the above to be added to my account. Further, if I no longer wish to receive communications via email and/or text from Heart of Iowa, I understand that I may call 641-486-2211 and opt out at any time (if calling after hours, please press option 3)
Account Name*
Account Number
Date

MonthDayYear
Signature*

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Password, Back-Up Question and Email/Text Delivery Authorization Form

Password & Back-Up Question

Back-Up Question (please answer ONLY one)

Email/Text Authorization