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Service Application

Ready to apply for service from Corn Belt Telephone? Let's get started!

To navigate this Conversational Application, you can use your keyboard by pressing [Tab] or [Enter] to advance, the [] or [] keys to page up or down, and Letter Keys to select your choices. You can also use your mouse to click through or scroll.

If you are on a mobile device or prefer a traditional form style, click here.

press Enter

First, We Need to Know a Couple of Things

Each service requires a refundable $50 deposit. I understand that the deposit must be paid in full prior to service activation.

Applicant Information

If you select yes, you will receive an email asking you to verify one of the security questions you choose below. To activate your eStatements, you must reply with the correct answer, verifying your identity.

Customer Proprietary Network Information (CPNI)

The FCC governs the use and disclosure of certain Customer Proprietary Network Information (CPNI) and require customers to establish a password to help protect that information. Corn Belt Telephone / Corn Belt Communications may respond to your inquiries regarding call detail information or certain account information in three ways:

1) you would have to provide your pre-established password

2) we could call the telephone number listed on your account or

3) we could mail the information to the address on record.

To establish your password, you must complete the info below. The password you choose CAN NOT be related to your family history or account information (account number, home address, social security number, mother’s maiden name, etc.). This form will establish a password and back-up question only for the purpose of service and account inquiries, including inquiries relating to CPNI.
The password you choose CAN NOT be related to your family history or account information (account number, home address, social security number, mother’s maiden name, etc.) Since it is a verbal password, there are no Case, Number or Special Character Requirements.
Select One
Type the answer to your selected security question.

Service Acknowledgments

Prior to selecting your services, please read and type your initials next to these service acknowledgements.
Type Your Initials
Type Your Initials ONLY if you wish to subscribe to Inside Wire Maintenance.

SERVICES

Now that we got all of that out of the way, it's time to select which services you want.

AUTOMATIC PAYMENTS

Although it is not required, we do offer convenient auto pay options for our customers. If desired, you can choose between an Automatic ACH Draft from your Checking or Savings Account, or Automatic Payments from your Credit or Debit Card.

We also offer Online Bill Pay, which allows you to schedule payments, make payment changes yourself and view your statements. You can sign up for Online Bill Pay at anytime after you receive your first statement at cornbelttelephone.com.

DISCLOSURES AND SIGNATURE(S)

THE DISCLOSURES

HIGH SPEED INTERNET SERVICE POLICY (IF APPLICABLE)
In the best interest of service quality, Corn Belt Telephone has adopted the following practices in regard to High Speed Internet Service Features. Corn Belt Telephone will provide High Speed Internet Service Features to a Subscriber with the following conditions known to the Subscriber via their signature on this policy statement. Internet Subscribers are bound by netINS, Inc. Acceptable Use Policy at www.netins.net/acceptable_use_policy. This service is provided over various means of infrastructure, including but not limited to twisted pair copper, coax cable, fiber optics and wireless transport. Although Corn Belt strives to provide quality and uninterrupted service, there is no guarantee of uninterrupted service or of service quality. Wireless services have many issues that can create service problems. Service is degraded by atmospheric conditions, the same as radio and television. Trees and other vegetation also create problems. If you have a lot of trees in your area or between your location and the tower site, you can experience service problems, even after working fine for months. Please understand these issues exist and are beyond our control. Connection speeds start at 3 Mbps, depending on service location and transport medium. All speeds are at best effort industry standards. No data rates are guaranteed. Disconnection of service can occur due to any of the following conditions: 1) Late payment for any reason, 2) Any unlawful use of services, 3) Redistribution of services outside subscribers subscribed address location, 4) Other subscriber issues not in the best interest of Corn Belt Telephone Company. Subscriber understands the loss of electrical power, for any reason, to the computer, modem, router, server, receiver, transmitter or any other network equipment, will cause service to fail. Subscriber also understands that this service can be discontinued by Corn Belt Telephone Company at any time, for any reason, without prior notice. The person signing this policy represents that he or she is the Authorized or designated Subscriber to the High Speed Internet Service Feature.

e-STATEMENTS (IF APPLICABLE)
This agreement provides consent to receive Customer Statements for service accounts for your Corn Belt Telephone Company, Inc. accounts by electronic delivery as they are available. The electronic service statements are called E-Statements. To receive your statements electronically, you will need access to the Internet and a device to receive and view your email. Additionally, you will need access to a printer or the ability to download the information, in order to keep copies for your records. By signing below, you understand and agree that you can meet these requirements. In order for your E-Statement to be delivered, the electronic delivery service will need to be tested and validated before electronic delivery can be initiated. Following enrollment for E-Statements, you will receive an email that you WILL NEED to respond to. When you validate your account with the email notification, the setup will be complete. You are responsible for providing us with updated contact information, such as changes to your email address. You may contact us in person at 108 Main Street, Wall Lake, Iowa 51466 or by phone at 712-664-2221 or by mail at PO Box 445, Wall Lake, Iowa 51466. Each statement period we will send you an email with your statement attached. You understand that you have a duty to exercise reasonable promptness in examining the E-Statement to determine whether account charges and/or payments received or not received are accurate. It is your responsibility to print the electronic statement or save it in an electronic format for future reference. You have the right to withdraw your consent to receive E-Statements at any time by canceling your enrollment in the service. You can do this by contacting us in person at 108 Main Street, Wall Lake, Iowa 51466 or by phone at 712-664-2221 or by mail at PO Box 445, Wall Lake, Iowa 51466. Please do not reply directly to the (no reply) email address sending your E-Statements. There is no fee to withdraw your consent to receive statements electronically. We will use commercially reasonable measures, consistent with industry standards, to maintain security of the information contained in the electronically delivered account statement(s) and notices. By signing below you are authorizing Corn Belt Telephone Company, Inc. to deliver statements for the Corn Belt Telephone Company, Inc. account(s) identified by electronic means. You understand and agree that by requesting electronic delivery, you will NOT receive statements in paper form delivered by regular United States Postal Service mail unless you specifically discontinue the E-Statement service as described in this disclosure. You agree that electronic delivery will satisfy Corn Belt Telephone Company, Inc.’s requirement to provide you a periodic statement of your account(s). Your consent shall remain valid until such time as you exercise your right to revoke this consent. Corn Belt Telephone Company, Inc. retains the right to discontinue this service at any time. Your E-Statement service can be discontinued if the email notice is returned undeliverable for any reason. Should your E-Statement service be discontinued, Corn Belt Telephone Company, Inc. will resume the paper delivery of your statement via the United States Postal Service.

AUTHORIZATION
A signature is required to activate services. By signing this application, I agree that the information provided within is true and correct to the best of my knowledge. For CPNI, by signing below, the customer is providing the company with express, written approval to use the enclosed password and back-up question before providing any information regarding service and account inquiries made by the account owner or designated account users. This approval includes responses to inquiries related to the customer’s services, to inquiries concerning call detail information and account information, including Customer Proprietary Network Information.
Your complete Service Disclosures are available to Print and/or save at cornbelttelephone.com/customer-disclosures
$ 0.00
The above amount is your Security Deposit due prior to Service Activation, in addition to any applicable Installation/Activation Charges. Upon receiving your application, we will contact you to set an Installation Date/Time and arrange for collection of Service Deposits and Installation/Activation Charges.