E911 Address

Address, City, State & Zip

Billing Address (if different than Service Address)

Address, City, State & Zip

Name in Directory

Landlord's Name (if renting)

Date Service Requested (Allow 2 business days)

Email

Current Employer Name & Number

I was referred to CTC by (Referrer will receive a $25 bill credit)

Customer Proprietary Network Information (CPNI)

Keeping your information private is important to us. In keeping with the Customer Proprietary Network Information (CPNI) rules, we are asking that you provide the information below, so that we can confirm with whom we are speaking when you contact us by phone. Additionally, you may add other ‘authorized’ users to your account. They can be anyone that you wish, or those that need to have access, to make changes to your account with us.

List Names You Wish to Have Access to Your Account

Your Mother's Maiden Name

Your Favorite Color

Requested Password

Customer Compliance Agreement & Authorization (Signature Required - Please Type Your Name)

By establishing account with CTC Technology or using any software provided, developed, licensed or owned by CTC, I agree to be bound by this Agreement and to use the Services in compliance with this agreement and other CTC’s policies posted from time to time on CTC’s website at www.ctctechnology.net. I understand that all charges are listed on this application are monthly and do not include taxes and regulatory fees. I authorize CTC Technologies to install all appropriate equipment for the services I have requested. I understand that all policies and procedures can be found on CTC’s website or given upon request. All adults are required to sign this application.

Application for Service

Contact

Office Location

Quick Links