Account Service Change

Subscriber Information

Name

Acct Number (if known):

Phone

Address

PIN/CPNI Information

According to FCC rules, only persons listed on your telephone bill can access or change information regarding your CPNI. You can add authorized users such as spouse, parents, children, employees, etc. to your account which would allow them to make changes or receive information about your account. They will need to know the password and/or verification questions to obtain any information regarding your account.

4 Digit PIN

If you do not know your 4 Digit PIN, please provide answers to both security questions below to verify your identity.

What is your favorite holiday?

What is your favorite color?

Account Information

Please select the box corresponding to the applicable change

Update mailing address

Add authorized users on my account

Remove authorized users on my account

Update phone number

Update email

Update mailing address to

Name #1

Name #2

Name #3

Name #4

Update phone number to

Update email to

Billing Information

I want to change how my statements are provided to me as follows:

Email to

Mail to this address

Service Information

Note: Some services are only available in select markets. CCT staff will contact you if your selection is not available for the market you are located in.

High-Speed Internet

I want to cancel my internet service on my account effective on

I want to put my internet service on my account in vacation status effective on:

(Must be on for a minimum of 3 and maximum of 10 months.)

I want to add my internet service to my account. (Please review our plans located HERE for pricing options)

Create Wi-Fi Name:

Create Wi-Fi Password:

I want to:

Increase my internet speed to:

Decrease my internet speed to:

50/50 Mbps

100/100 Mbps

250/250 Mbps

500/500 Mbps

1/1 Gbps

3/3 Gbps (call for pricing)

5/5 Gbps (call for pricing)

10/10 Gbps (call for pricing)

Telephone Service

I want to cancel telephone service on my account effective on

I want to put my telephone service on my account in vacation status effective on

(Must be on for a minimum of 3 and maximum of 10 months.)

I want to add my telephone service to my account. (Please review our plans located HERE for pricing options)

I want to:

have a new number assigned

port (bring with) me my number:

Current Phone Number

Who is your long-distance carrier?

Note: If one is not identified, CCT will be selected as the default carrier at $0.12 per minute. Also, if your phone plan has any free long distance you cannot opt for a different carrier, please mark CCT or leave this field blank. If you do not wish to have long distance, please indicate “No Long Distance” in the field.

Authorization/Approval Section

I agree that the above information provided is true and accurate to the best of my knowledge and I further understand that any information falsely documented may constitute grounds for violation of local, state, or national laws and I could be subject to prosecution. I hereby acknowledge and agree that when I type my name in the space provided below, it serves as my electronic signature, and I intend to be legally bound by the content of the document to which this electronic signature is affixed. I understand that this electronic signature is considered the equivalent of my handwritten signature and holds the same legal validity and enforceability. By typing my name and proceeding, I am electronically signing and executing this document as of the date I affix my electronic signature.

Signature(Required)

Date(Required)

Account-Service Change