Seasonal Customer Departure

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Seasonal Customers Departure

 

Your Name (required)

Your Email (required)

Phone Number (required)

Your Service Address (required)

Your Service City (required)

Your Service State (required)

Your Service Zip Code (required)

Date Service Suspension is Requested
As of 1/1/2017, Service Suspension will only take place on the billing cycle (the 15th of the month) Please keep this in mind when planning your seasonal disconnect. (required)

Suspend All Active Services? (required)
YesNo

If No, Which Services Would You Like Turned Off?

Cable TV
YesNo

Internet
YesNo

Telephone
YesNo






Where would you like final billing and credit balance refunds to be mailed to?

Your Mailing Street Address

Your Mailing Address City

Your Mailing Address State

Your Mailing Address Zip Code

Special Instructions or Notes

By checking this box I understand that I am requesting my selected Corn Belt Telephone services and billing to suspend, on the date I specified, at the address I specified. (required)

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