Online Service Sign Up

Section One - Customer Information

Date of Birth(Required)

Your DOB and SSN are encrypted upon submission and stored on our secure servers. Alternatively, you may choose to provide your SSN in person for added convenience and security.

Social Security Number

Your DOB and SSN are encrypted upon submission and stored on our secure servers. Alternatively, you may choose to provide your SSN in person for added convenience and security.

Please enter a number from 0 to 999999999.

Contact Phone Number(Required)

CPNI Password Set Up

Under the new FCC rules governing the use and disclosure of Customer Proprietary Network Information (CPNI), there are certain circumstances under which Farmers Telephone Company LLC may be permitted to respond to your inquiries regarding call detail information or certain account information only by the customer providing a pre-established password, the company calling the telephone number listed on the account, or the company sending such information to the mailing address or electronic address of record.

Password

Confirm Password

Security Question: What is your favorite color?

List other individuals allowed to make changes on your account (if applicable)

Name:

Phone Number:

Name:

Phone Number:

Name:

Phone Number:

Section 2 - Internet Service

**Availability varies by location.** Farmers Telephone Company/Heartland.net Fiber and Wireless connections are NOT available in all areas.

Section 3 - Telephone Service

Quantity of Phone Lines Needed

If Yes, please list numbers to Port.

Section 4 - Television Service

Fiber Only. Not Available to Wireless Customers.

Section 6 - Signature

All customer proprietary network information (CPNI) is kept confidential.

Customer Signature(Required)
By typing your name below, you acknowledge that it is legally equivalent to your signature and represents your agreement to the terms and conditions outlined in this form.

Initial Here(Required)
By typing your initial below, you acknowledge that it is legally equivalent to your signed initial and represents your agreement to the terms and conditions outlined in this form.

Date Signed

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Your Feedback Matters: Help Us Serve You Better

Section One - Customer Information

CPNI Password Set Up

Section 2 - Internet Service

Section 3 - Telephone Service

Section 4 - Television Service

Section 6 - Signature

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