2025/26 New Customer Phone - WITH Phone Line

NEW CUSTOMER FORM - WITH Phone Line

Application for Membership and Services, Lease Agreement, CPNI Authorization, Auto-Withdrawal, Paperless Billing & Web Account and Fiber Fast Notifications
Application for Membership and Services
The undersigned (hereafter called "Applicant") applies for membership in, and agrees to take services from Northeast Nebraska Telephone Company (NNTC) organized under the laws of the State of Nebraska upon the following terms and conditions:
1. The Applicant will pay a non-refundable service order and connection charge.
2. The Applicant will take from NNTC to be used on their premises and will pay monthly rates and charges to be determined from time to time in accord with applicable tariffs and the By-laws. The Applicant will comply with, and be bound by, the provisions of the Articles of Incorporation and Bylaws of NNTC, and such rules and regulations as may from time to time be adopted by the Board of Directors of NNTC for the common objective of better and more economical services to the Membership.
3. The Applicant, by becoming a Member, assumes no personal liability or responsibility for any and all debts or liabilities of NNTC, and it is expressly understood that the Applicant's private property is exempt from execution for any such debts or liabilities. The service obligation of NNTC is limited to those facilities installed, owned and maintained by NNTC. The extent of liability for services rendered over such facilities is contained in the applicable tariffs published by NNTC.
This application is made in consideration of similar applications by other Members and is understood to be an agreement with the other Members of NNTC and NNTC itself.
Membership Type:*

Single MembershipJoint Membership
Customer Name:*

First NameLast Name
SSN/FID:*
Date of Birth: *

MonthDayYear
Date
Driver's License State and Number:*
(ex. NE - N00000328)
Additional Customer Name (for Joint Membership):

First NameLast Name
Additional Customer SSN (for Joint Membership):
Add'l Customer DOB:

MonthDayYear
Date
Customer Address (Physical Address):*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (If different than above):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Customer Cell Phone Number: *

Area CodePhone Number
Customer Email Address:*
example@example.com
Customer's Employer: *
Employer's Phone Number: *

Area CodePhone Number
Relative Name & Relationship:*
We ask for a relative who does not live in your home in case we owe you money and your address on file is no longer valid.
Relative's Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relative's Phone Number:*

Area CodePhone Number
Equipment Lease Service Agreement
Thank you for choosing Northeast Nebraska Telephone Company (herein after referred to as “NNTC”) for your telecommunications service. By signing this Service and Equipment Lease Agreement, you agree to abide by NNTC’s service terms and conditions. NNTC leased equipment is defined as items you will have in your possession but are still owned by NNTC. Examples include but are not limited to: DVR set-top box(es), non-DVR set-top box(es), handheld remote control(s), ONT(s), router(s) and/or router extender(s).

THIS SERVICE AND EQUIPMENT LEASE AGREEMENT CONTAINS THE TERMS AND CONDITIONS FOR THE LEASE BY NNTC. YOU UNDERSTAND AND AGREE THAT YOU HAVE NOT PURCHASED THE EQUIPMENT, YOU DO NOT OWN THE EQUIPMENT AND THE EQUIPMENT MUST BE USED AND RETURNED TO NNTC IN ACCORDANCE WITH THE TERMS OF THIS SERVICE AND EQUIPMENT LEASE AGREEMENT.
1. PROGRAMMING AGREEMENT - On the date that the professional installer installs the equipment, you agree to activate the equipment ordered by you or provided to you with any NNTC service. NNTC PRICING IS SUBJECT TO CHANGE AT ANY TIME.
2. CARE OF EQUIPMENT - You are responsible for the loss of or any damage to the equipment that you lease from NNTC. You shall have no right to sell, give away, transfer, pledge, mortgage, remove, relocate, alter or tamper with the equipment at any time. NNTC PROVIDES YOU WITH THE EQUIPMENT AS IS, AND MAKES NO WARRANTY, EITHER EXPRESSED OR IMPLIED, REGARDING THE EQUIPMENT PROVIDED TO YOU. ALL SUCH WARRANTIES INCLUDING, WITHOUT LIMITATION, THE IMPLIED WARRANTIES OR MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE, ARE EXPRESSLY EXCLUDED. NNTC IS NOT RESPONSIBLE FOR ANY SPECIAL, INCIDENTAL OR COINCIDENTAL DAMAGES RELATING TO THE EQUIPMENT PROVIDED TO YOU. In the event the equipment you have leased from NNTC does not operate correctly, contact NNTC at 1.888.397.4321 during the hours of 8:00 a.m. through 4:30 p.m. Monday through Friday. You may also email us at nntc@nntc.net, but you will not receive a reply until hours of operation.
3. RETURN OF EQUIPMENT - If you disconnect/cancel/terminate service on some or all your leased equipment for any reason (to replace or upgrade equipment, or to cease being an NNTC customer either voluntarily or involuntarily), or if you decide to disconnect/cancel/terminate your services, you are responsible for getting that equipment to NNTC’s main offices at 110 East Elk Street P.O. Box 66, Jackson, NE 68743 within 30 days of such disconnection/cancellation/termination. You acknowledge that the equipment belongs to NNTC and the equipment must be returned to NNTC in good working order, normal wear and tear excepted. You agree that you are responsible for paying the following minimum fee(s) in the event you fail to return any leased equipment or return the equipment in a damaged condition. The below amounts are priced on a per-unit basis:

Remote - $20 DVR STB - $300 Non-DVR STB - $175
Router - $150 Router Extender - $125 Innovative Box - $175 ONT - $250
Do you agree to the terms of the lease agreement and wish to have an NNTC supplied router in your home?*

Yes (Answer the Wi-Fi Router questions)No (Continue to CPNI)
Wi-Fi Router User Name (pick a user name):
at least 8 character of any type
Wi-Fi Router Password (pick a PW):
CPNI / Authorized Account Users
The FCC has implemented rules to protect the privacy of information contained in your telephone account with Northeast Nebraska Telephone Company. The rules allow us to discuss account information ONLY with the person(s) listed on the account. Also, we must be able to authenticate that person and will do that by asking a specific question to which you have previously provided us the answer (See question below). Although we have always treated your account information with confidentiality, please help us in our effort to further ensure that we protect the information, by completing the following Authentication Question: Please provide your Social Security Number or the last four digits of your SSN.
Primary Phone Number:*

Area CodePhone Number
Additional Phone Number:

Area CodePhone Number
Authorized Account Representatives If your account is listed only in your name, you might want to consider adding another name, if appropriate, e.g., a spouse, parent, child or roommate. If you are a parent or individual that relies on someone else to discuss account changes, payments or anything else with our company, you will need to have that person’s name added to your account. The name does not need to be added to the billing name but can be added to our records as an authorized person for discussing information and making changes to your account. The additional contact(s) that you authorize will NOT be listed in the telephone directory, be responsible for payment of this account, or be entitled to any of the capital credits or voting privileges associated with this account.
Choose an option:*

No, I do not want to add any additional authorized contacts to my accountYes, I would like to add the following as authorized contacts for my account (specify below).
Authorized Contact #1
Name:

First NameLast Name
Last Four Digits of SSN:
Contact Phone Number:

Area CodePhone Number
Relationship:
Authorized Contact #2
Name:

First NameLast Name
Last Four Digits of SSN:
Contact Phone Number:

Area CodePhone Number
Relationship:
Authorized Contact #3
Name:

First NameLast Name
Last Four Digits of SSN:
Contact Phone Number:

Area CodePhone Number
Relationship:
Authorization Information
Authorized by (name of person on account):*

First NameLast Name
Account Relationship (Ex. Owner, President, etc.):*
Type a question*

Click here to confirm you have read the CPNI agreement and agree to its terms.
Auto-Withdrawal (Optional)

Bills are received on or about the 1st of the month, auto-withdrawals from a bank account or credit card are posted to your account on the 15th, unless the 15th falls on a weekend or holiday, then the following business day.
I (we) hereby authorize NNTC to initiate debit entries (autopay) for my (our) monthly bill to:

Checking AccountSavings AccountCredit/Debit Card (A 3.5% fee will be added)

Paperless Billing & Web Account (Optional)

a $1.50 fee will be added per month to paper bills sent in the mail.
We will create a web account for you using the the temporary password you type in below. You will be able to login to your account with the temporary password after 3 business days once this form has been submitted. You can log-into your account by going to www.nntc.net and click "My Account". You'll be asked to change your password at that time.
Email address for paperless bill and web account:
example@example.com
Fiber Fast Internet Usage Alerts
If you would you like to receive notifications from NNTC in $20 increments of data usage, please choose how you'd like to be contacted:

EmailText MessageBoth
Cell Phone Number for notifications:

Area CodePhone Number
Cell Phone Provider:
Email Address for notifications:
example@example.com
Electronic Signature By typing and signing your name below, you agree this is an electronic signature, authorizing you have filled out the following forms with NNTC and agree to their terms, conditions and acceptable use policy found on our website:
1. Application for Membership and Services
2. Lease Agreement (this is optional)
3. CPNI Authorization
4. Auto-Withdrawal (this is optional)
5. Paperless Billing & Web Account (these are optional)
6. Fiber Fast Notifications (this is optional)
Signature:*

First NameLast Name
Signature with mouse / finger / stylus:*
Today's Date:*

MonthDayYear
Date
Should be Empty:

NEW CUSTOMER FORM - WITH Phone Line

Application for Membership and Services

Equipment Lease Service Agreement

CPNI / Authorized Account Users

Auto-Withdrawal (Optional)

Paperless Billing & Web Account (Optional)

Fiber Fast Internet Usage Alerts