First Name
*
Last Name
*
Phone Number
*
Email
*
Confirmation Email
Service Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Date to resume service
*
-
Month
-
Day
Year
Service must be resumed on a weekday. If a weekend date/holiday is selected, service will resume on the prior business day.
Resume all prior services?
*
Yes
No
If no, which services do you want to resume?
Internet
Cable TV
Telephone
Do you have a different mailing address?
*
Yes
No
Mailing Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Notes
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Yes, I am requesting that Corn Belt Telephone resume my services indicated above, on the date indicated above. I understand that if I have chosen a non business day for service to resume, service will be re-activated on the prior business day. I understand that billing for these services will resume on the date I have indicated above.
*
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