Welcome to Central Texas Telephone Cooperative!
We are excited you have chosen to live in rural Texas! Our
Cooperative is dedicated to providing you with the very best in
telecommunications.
Please print out this packet of information and complete the
forms in full. Once completed, you may either mail the forms or fax
them back to us. However, if you choose to fax them, we will need the
original completed application forms along with any funds required
prior to installation/activation.
If you have any questions, please call our Customer Service
Office at 1-325-648-2237 or 1-800-535-8904.
Once again, we welcome you and look forward to you being a part
of Central Texas Telephone Cooperative! We are here to serve you!
Sincerely,
CENTRAL TEXAS TELEPHONE COOPERATIVE, INC.
CENTRAL TEXAS TELEPHONE COOPERATIVE, INC.
PO Box 627 · Goldthwaite, TX 76844
www.centex.net (325)648-2237 or (800)535-8904
APPLICATION FOR MEMBERSHIP AND TELEPHONE SERVICE
Please complete and return with an estimated installation / name change fee of $ ____________________
Have you had service with our Cooperative before?
If yes, under what telephone number? _________________________
Type of Service you are requesting:
t Venture
Business Name (if applicable) _____________________________________________
Business Tax ID # ____________________________
(Required)
If tax exempt, from which of the following?
(An applicable exemption certificate must be provided for each)
Individual Account Name (Member)__________________________________________________________________________________________
Billing Address __________________________________________________________________________________________________________
Social Security # __________________________ Driver’s License # ________________________ Contact Email Address _________________
Is a “joint membership” between husband and wife sought?
Spouse Name (Required if applying for joint membership) ________________________________________________________________________
Spouse Social Security # ____________________ Spouse Driver’s License # __________________ Spouse Contact Email __________________
FEATURES
Custom Calling Features
Monthly
Monthly
Residential Business
Touch Tone (Required) *
$1.25
$1.25
Call Waiting/Cancel Call Waiting
$1.50
$2.00
Call Forwarding
$1.50
$2.00
$1.75
$2.75
$1.75
$2.75
$2.75
$3.75
$2.50
$3.75
$4.75
$3.50
$5.00
$6.00

3-Way Calling

Speed Dialing 8#

 Speed Dialing 30# *

If purchased in a package:
2 Features
3 Features
4 Features
* Not included in Package Offerings
Class Features
Monthly
Automatic Call Back
Automatic Recall
Anonymous Call Rejection
Anonymous Call Rejection (when purchasing Caller ID)
Selective Distinctive Ringing/Call Waiting
Selective Call Acceptance
Selective Call Rejection
Selective Call Forward
Call Forward No Answer
Call Forward Busy
Call Forward Busy and No Answer
Remote Call Forward
Caller ID Number Delivery *
Caller ID Name Delivery *
Caller ID Name & Number Delivery *
Call Waiting ID (Caller ID feature required) *
Call Trace - each successful trace activation *
$2.00
$2.00
$1.00
$0.50
$2.00
$2.00
$2.00
$2.00
$1.50
$1.50
$2.00
$2.00
$3.50
$3.50
$6.50
$1.50
$8.00
If purchased in a package:
Optional Services
Extended Local Calling
(Please inquire into availability and pricing)
$3.00
$4.00
$5.00
* Not included in Package Offerings
Help Line
$1.00
Help Line (when subscribing to any other feature
excluding Touch Tone)
$0.75
Inside Wire Maintenance (approval required)
$1.50
Voice Mail - Residential
$3.95
Voice Mail - Business
$7.95
Additional Mailboxes for Residential or Business
Please indicate quantity __________
$1.00
Office use only:
Rev 01.06.15
2 Features
3 Features
4 Features
Monthly
Optional Blocking Services
Monthly
Residential
Toll Block Collect Calls
Toll Block 3rd Number Calls
Toll Control w/ PIN
Toll Block 1+ and 0+ Calls
Toll Block 900 & 976 calls

Free
Free
$2.00
$1.75
$0.00
(A non-recurring service charge will apply to 900 & 976 changes
made after initial application request)
Membership # _____________________
Telephone #______________________
New Member Applicant
Date Received _____________________
Amount
Existing Member/Membership Conversion
Cash

Check # __________
$ _____________________
Credit Card
Monthly
Business
Free
Free
$2.00
$2.25
$0.00
CENTRAL TEXAS TELEPHONE COOPERATIVE, INC.
APPLICATION FOR MEMBERSHIP AND TELEPHONE SERVICE, PAGE 2
LONG DISTANCE CARRIER
PLEASE SELECT THE LONG DISTANCE CARRIER OF YOUR CHOICE
Please see the attached list and select your IntraLATA and InterLATA long distance carrier.
I choose ____________ as my IntraLATA long distance carrier.
Signature _________________________________________
I choose ____________ as my InterLATA long distance carrier.
Date _______________________
DIRECTORY INFORMATION
List in Directory as: ______________________________________ Directory Address ______________________________________________________
(911 Address or PO Box only – No City Listed)
Extra Directory Listings ($.25 residence, $.50 business Per Month)
List in Directory as: _____________________________________ Directory Address _____________________________________________________
(911 Address or PO Box only – No City Listed)
No
(You may be contacted by our contracted directory publisher for additional information).
If yes, list heading you prefer (ie., Hardware, Plumbers, Grocers): _______________________________________________________________________
AUTHORIZATION TO ENTER PREMISES
I/We do hereby authorize and request that Central Texas Telephone Cooperative, Inc. allow its employees to enter any residence or other
building that I/We own for the purpose of installing, repairing or servicing telecommunications equipment when I am not physically
present at such residence or other building. This authorization shall remain effective until it is revoked by a written revocation signed by
me and filed with the home office of Central Texas Telephone Cooperative, Inc. in Goldthwaite, Texas.
EXECUTED THIS ______________ DAY OF __________________________, 20_________
_____________________________________
Signature
___________________________________
Spouse Signature (if applicable)
SAFETY PRECAUTIONS
Are the animals aggressive?
Do you have animals on your property?
Are they restrained?
LOCATION OF PROPERTY FOR TELEPHONE SERVICE
IF CONSTRUCTION IS REQUIRED TO PROVIDE SERVICE TO YOUR LOCATION, AN EASEMENT WILL BE REQUIRED
Telephone number where you may be reached concerning installation_____________________________________________________
911 Address (required) _________________________________________________________________________________________
Inside city limits?
If yes, what city?____________________________________________________________________
County Location_______________________________________ School District Location ___________________________________
If yes, please list the previous occupants’ name and telephone number ____________________________________________________
Is the building wired for a telephone?
Yes
Description of Property and House _______________________________________________________________________________
____________________________________________________________________________________________________________
Neighbors or Road on the:
North _____________________
East ____________________ West ____________________
South ______________________
If you are not the landowner, please give the landowner’s name and phone #, if known. ______________________________________
____________________________________________________________________________________________________________
PLEASE HELP US FIND YOUR HOUSE. Using the back of the application or a separate sheet, draw a map of the location where
you want service. Indicate highways, county road numbers, and any significant landmarks that may assist us in locating the property.
CENTRAL TEXAS TELEPHONE COOPERATIVE, INC.
APPLICATION FOR MEMBERSHIP AND TELEPHONE SERVICE, PAGE 3
Office Use Only:
Member # _______________
Telephone #______________
MEMBERSHIP OPTIONS AND AGREEMENT
One of the following membership options MUST be selected:

1. I have not had phone service with CTTC previously. I wish to procure telephone service from the Cooperative and thereby establish membership with the
Cooperative.
Please check one:
(Individual or Business)
Please note, in order for a husband and wife to hold a joint membership, both parties must sign this application. When both sign, the term “member” shall be
deemed to include a husband and wife holding a joint membership and any provisions relating to the rights and liabilities of membership shall apply equally with
respect to the holders of the joint membership. The vote of either separately or both jointly shall constitute one vote as a member of the Cooperative.

2. I have previously had membership with CTTC as a single individual or business operating under my social security number. My marital status or business
form has not changed and I thereby wish to re-establish service under the member number previously assigned to my account.

3. I currently have service with the Cooperative. My marital status has changed and I thereby wish to apply for a new single membership with the
Cooperative. I understand that all capital credit allocations under the previous joint membership will remain in the joint names only and cannot be transferred to a
single membership unless addressed in a divorce decree and provided to the Cooperative.

4. I currently have service with the Cooperative. My marital status has changed and I thereby wish to apply for a new joint membership with the
Cooperative. I understand that all capital credit allocations under my previous single membership will remain in my name only. Upon my death, these allocations
cannot be transferred to my spouse. I understand in applying for joint membership that, in order for a husband and wife to hold a joint membership, both parties
must sign this application. When both sign, the term “member” shall be deemed to include a husband and wife holding a joint membership and any provisions
relating to the rights and liabilities of membership shall apply equally with respect to the holders of the joint membership. The vote of either separately or both
jointly shall constitute one vote as a member of the Cooperative.

5. I currently have service with the Cooperative. My marital status has changed and I thereby wish to convert my single membership to a joint membership
as provided in the Cooperative’s By-Laws Article 1 Section 4(a) which states that “A membership may be converted to a joint membership upon the request of the
holder thereof and the agreement by such holder and his or her spouse to comply with the articles of incorporation, By-Laws, and any rules and regulations adopted
by the Board.” I understand that the membership certificate shall be reissued by the Co-op in such a manner as shall indicate the changed membership status and that
all capital credit allocations under my single membership will be transferred from my single membership to my joint membership from the date of original
application continuing until disconnection of telephone service. Upon death of either spouse who is a party to the joint membership, such membership shall be held
solely by the survivor.

6. I currently have service with the Cooperative and hold a joint membership with my deceased spouse. I wish to convert the joint membership to a single
membership in accordance with Article 1, Section 4(b) of the Cooperative’s By-Laws which state “Upon the death of either spouse who is a party to the joint
membership, such membership shall be held solely by the survivor. The outstanding membership certificate shall be surrendered, and shall be reissued in such
manner as shall indicate the changed membership status, provided, however, that the estate of the deceased shall not be released from any debts due the Co-Op.”

7. I currently receive service with the Cooperative through the single membership of my deceased spouse. I understand that all capital credit allocations
under the single membership of my deceased spouse shall remain in that name only and cannot be transferred to me. However, I wish to continue receiving
telephone service from the Cooperative and thereby request to establish a single membership with the Cooperative. In doing so, I understand that I may still have the
directory listing in the name of my deceased spouse or other listing that I may choose.
The undersigned (hereinafter called the “Applicant”) hereby applies for membership in and agrees to take telephone service from a corporation organized under the laws
of the State of Texas under the name of Central Texas Telephone Cooperative, Inc. (hereinafter called “Cooperative”), for the purpose of furnishing telephone service,
upon the following terms:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
The Applicant will pay upon signing this application, an estimated installation fee as set forth in the General Exchange Tariff of the Cooperative. An
additional deposit may also be required to establish credit.
The Applicant will, when telephone service becomes available, take from the Cooperative, telephone service to be used on the premises described herein and
will pay monthly at rates to be determined from time to time in accordance with the procedure specified in the By-Laws of the Cooperative. It is expressly
understood that all amounts paid by the Applicant in excess of the operating costs of the Cooperative are furnished by the Applicant as capital and the
Applicant shall be credited with the capital so furnished as provided by the By-Laws.
By signing this application, providing the Applicant is the owner, the Applicant does grant to the Cooperative a right-of-way easement of not less than
twenty (20) feet wide to construct, operate and maintain a telephone line or system on the land described, to cut and trim trees and shrubbery that may
interfere with or threaten to endanger the operation and maintenance of said line or system and in or upon all streets, roads or highways abutting said
land.
The Applicant will comply with and will be bound by the provisions of the Charter and By-Laws of the Cooperative and such rules and regulations as may
from time to time be adopted by the Cooperative.
The Applicant, by becoming a member, assumes NO personal liability or responsibility for any debts or liabilities of the Cooperative, and it is expressly
understood that his private property is EXEMPT from execution for any such debts or liabilities.
Applicant agrees that venue will be fixed in state district court in Mills County, Texas for the resolution of any and all types of claims or conflicts between
Applicant/Member and the Cooperative.
All payments are due and payable at the Cooperative’s place of business or as stated on your telephone bill.
The Cooperative may, at any time, and at its sole discretion, revoke the privilege of extending credit to the Applicant for future services.
The Cooperative, or its designee, is expressly authorized to investigate any references, and other information furnished by the undersigned Applicant, or by
any other person or entity pertaining to the undersigned Applicant’s creditworthiness.
This application authorizes the Cooperative or its designee to verify Applicant’s creditworthiness by obtaining a credit report, or by directly contacting banks,
lending institutions, and suppliers in connection with this application or later in connection with an update, and specifically agrees to a continuing verification
as to any trade, credit or bank reference by the Cooperative from year-to-year until said account is paid in full, or this authorization is revoked in writing.
If any clause or provision of this Application is found to be invalid or is incapable of being enforced by any rule of law or public policy, all other clauses and
provisions shall, nevertheless, remain in full force and effect.
***IF CONSTRUCTION IS REQUIRED TO PROVIDE SERVICE TO YOUR LOCATION, AN EASEMENT WILL BE REQUIRED***
__________________________________________
Applicant Signature (Individual or Business)
__________________________________________
Printed Name (and title, if business)
____________________
Date
__________________________________________
Spouse Signature (required for joint membership)
__________________________________________
Printed Name
____________________
Date
W-9
Form
(Rev. December 2011)
Department of the Treasury
Internal Revenue Service
Request for Taxpayer
Identification Number and Certification
Give Form to the
requester. Do not
send to the IRS.
Print or type
See Specific Instructions on page 2.
Name (as shown on your income tax return)
Business name/disregarded entity name, if different from above
Check appropriate box for federal tax classification:
Individual/sole proprietor
C Corporation
S Corporation
Partnership
Trust/estate
Exempt payee
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) ▶
Other (see instructions) ▶
Address (number, street, and apt. or suite no.)
Requester’s name and address (optional)
City, state, and ZIP code
List account number(s) here (optional)
Part I
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on the “Name” line
to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN on page 3.
Social security number
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose
number to enter.
Employer identification number
Part II
–
–
–
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subject to backup withholding, and
3. I am a U.S. citizen or other U.S. person (defined below).
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage
interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and
generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the
instructions on page 4.
Sign
Here
Signature of
U.S. person ▶
Date ▶
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Purpose of Form
A person who is required to file an information return with the IRS must
obtain your correct taxpayer identification number (TIN) to report, for
example, income paid to you, real estate transactions, mortgage interest
you paid, acquisition or abandonment of secured property, cancellation
of debt, or contributions you made to an IRA.
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN to the person requesting it (the
requester) and, when applicable, to:
1. Certify that the TIN you are giving is correct (or you are waiting for a
number to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S. exempt
payee. If applicable, you are also certifying that as a U.S. person, your
allocable share of any partnership income from a U.S. trade or business
is not subject to the withholding tax on foreign partners’ share of
effectively connected income.
Note. If a requester gives you a form other than Form W-9 to request
your TIN, you must use the requester’s form if it is substantially similar
to this Form W-9.
Definition of a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are:
• An individual who is a U.S. citizen or U.S. resident alien,
• A partnership, corporation, company, or association created or
organized in the United States or under the laws of the United States,
• An estate (other than a foreign estate), or
• A domestic trust (as defined in Regulations section 301.7701-7).
Special rules for partnerships. Partnerships that conduct a trade or
business in the United States are generally required to pay a withholding
tax on any foreign partners’ share of income from such business.
Further, in certain cases where a Form W-9 has not been received, a
partnership is required to presume that a partner is a foreign person,
and pay the withholding tax. Therefore, if you are a U.S. person that is a
partner in a partnership conducting a trade or business in the United
States, provide Form W-9 to the partnership to establish your U.S.
status and avoid withholding on your share of partnership income.
Cat. No. 10231X
Form W-9 (Rev. 12-2011)
CENTRAL TEXAS TELEPHONE COOPERATIVE, INC.
CUSTOMER PROPRIETARY NETWORK INFORMATION
(CPNI)
Important Customer Notice
Federal law and regulations require Central Texas Telephone Cooperative (CTTC) to protect the privacy of
your call detail information on file with CTTC. This information includes specific telephone call data, such as
the number called, time, location, or call duration. The rules prohibit CTTC from releasing any call detail
information during customer-initiated telephone contact without first verifying that the identity of the caller
matches the customer name on the account.
The FCC has expressed concern that individuals “pretending” to be customers are attempting to obtain call
detail information from telecommunications companies by calling to discuss “billing questions.” Consequently,
the rules require CTTC to verify that a customer calling is really actually the customer. Accordingly, CTTC
will share call detail information only with you, our customer, under two circumstances: a) you may come into
our office to ask questions and present a valid photo ID matching the name on the account; or, b) you can call
us with your billing questions and tell us the call detail information on your bill that you are questioning, such
as telephone number called and time of call.
If you decide to call us with a billing question but do not have a copy of your bill, the FCC’s rules provide three
alternatives:
(1)
You can ask us to call you back to discuss your billing questions. However, we can only call the
telephone number that is listed on your account;
(2)
You can request that a copy of your bill be sent to you at the billing address listed in our account
records. When you receive it, you can call us and provide the call detail information when you
ask your question; or,
(3)
You can provide us with a pre-established password, and then we can discuss your billing
questions.
If you wish to establish a password for your account to facilitate the discussion of your billing questions over
the phone, please contact a CTTC Customer Service Rep at (325) 648-2237 or (800) 535-8904.
In addition, if you wish to add an individual as an authorized user of your account, and enabling that individual
to obtain call detail information on your behalf, please contact us. If you wish to rely on someone else to
discuss account changes, payments, or any call detail information, you must add that person’s name to your
account. Any contact(s) that you authorize will not be responsible for payment of this account.
CENTRAL TEXAS TELEPHONE COOPERATIVE, INC.
IMPORTANT CUSTOMER NOTICE REGARDING
CUSTOMER PROPRIETARY NETWORK INFORMATION
Federal law protects your privacy rights as a customer of Central Texas Telephone Cooperative (CTTC). These
rights are in addition to the existing safeguards that CTTC already has in place to ensure your privacy rights.
The Federal Communications Commission (FCC) requires CTTC to notify you as a subscriber of your right to
restrict the use of, disclosure of, and access to your Customer Proprietary Network Information (CPNI). You
have the right, and CTTC has a duty, under Federal law, to protect the confidentiality of your CPNI.
CPNI: CPNI is information you might consider private and therefore wish for CTTC to protect it from use for
marketing purposes. CPNI is information CTTC possesses solely due to the customer-carrier relationship that is
necessary for the company to serve your telecommunications needs. CPNI is defined by the FCC as information
that relates to the quantity, technical configuration, type, destination and amount of use of a
telecommunications service subscribed to by any customer of a telecommunications carrier and that is made
available to the carrier by the customer solely by virtue of the carrier-customer relationship; and information
contained in the bills pertaining to telephone exchange or toll service received by a customer of a carrier. CPNI
does not include information that is in the public domain or available from other, non-Company sources. For
example, census data, subscriber list information and published directory information is public data.
PERMITTED USE OF CPNI BY COMPANY WITHOUT YOUR PERMISSION: CPNI can be used by
the CTTC for certain purposes without your permission. CTTC may use CPNI to offer you new or enhanced
services that are related to the category of services to which you currently subscribe. CTTC may also use CPNI
to respond to your inquiry regarding services you currently use or related services CTTC offers. In addition,
CTTC may use CPNI in connection with repair and maintenance services, billing and collection, to protect
CTTC property and to prevent fraud.
PROHIBITED USE OF CPNI UNLESS AUTHORIZED BY YOU: Without your authorization, CTTC may
not use your CPNI to market other communications services that it provides that are unrelated to the services
you already purchased. For example, CTTC may not use CPNI to offer you any type of long distance or
wireless service unless you currently subscribe to such long distance or wireless services. In addition, CTTC
may not share CPNI with any other company, including our affiliate that offers communications related
services, unless you are also a customer of our affiliate.
MAY WE USE YOUR CPNI TO BETTER INFORM YOU OF OTHER SERVICE OFFERINGS?
CTTC and its affiliate company provide a vast array of telecommunication services including local, long
distance, wireless TV and Internet access. We want to assure you that we always take great care in the way that
we handle sensitive information that pertains to your account, known as CPNI. CTTC requests permission to
use your CPNI to more effectively meet your telecommunications needs. CTTC might want to contact you to
advise you of new services, pricing alternatives or special offers that CTTC believes may interest you based on
the telecommunications services you currently purchased.
CENTRAL TEXAS TELEPHONE COOPERATIVE, INC.
IMPORTANT CUSTOMER NOTICE REGARDING
CUSTOMER PROPRIETARY NETWORK INFORMATION
Page 2
With your permission, only CTTC and its affiliate, will use your CPNI. CPNI data will not be shared with any
other company or entity without your approval, except to provide the service or services to which you are
already subscribed, or where we are required or authorized by law, regulation or other controlling authority to
share the information with an outside party.
With this in mind, we would like you to know that FCC regulations give you a choice—a choice about how
CTTC can use your CPNI to let you know about the availability of innovative services offerings that you may
have not anticipated or even knew that we were able to provide. You will also be able to enjoy savings and may
even be able to combine all these services on one monthly bill.
If you agree to give CTTC permission to use your CPNI, you do not need to take any further action.
If you do not agree to give CTTC permission to use your CPNI as described, you may “opt-out” by notifying
us within the next 30 days in the following manner:
(1)
Call the CTTC office at (325) 648-2237 or (800) 535-8904 within 30 days to register your
request. You may call anytime, twenty-four hours a day, seven days a week; or
(2)
Complete the information below and return it to CTTC, PO Box 627, Goldthwaite TX 76844; or,
(3)
E-mail CTTC at www.centex.net. Be sure to include in your email the name that appears on
your account with CTTC, the telephone number associated with your account and a statement
that you wish CTTC to “restrict use of my CPNI.”
“OPTING OUT” DOES NOT AFFECT YOUR CURRENT SERVICE: The restriction will remain in effect
until you notify us otherwise. Restricting use of your CPNI will not affect the services that you currently have
with CTTC and its affiliate. Please note that restricting your CPNI will not eliminate all of our marketing
contacts with you. You could still receive marketing contacts from us that are not based on your CPNI. Also,
CTTC and its affiliate may use your CPNI to contact you about service offerings related to the services to which
you already subscribe or to market other service offerings with your permission in the context of a customer
service call.
YOU CAN ALWAYS CHANGE YOUR MIND: You can always change your mind about CTTC’S use of
CPNI simply by telling us. Your instructions will remain in effect until you revoke or limit that approval or
denial. (Please be aware that every two years, you will receive a notice similar to this one to remind customers
of their options). Regardless of whether you decide to “opt out” or not, CTTC is committed to continuing to
provide you with the same high quality services that you have come to expect from us.
If you have any questions, or would like additional information regarding our use of CPNI, please contact
customer service at (325) 648-2237 or (800) 535-8904.
CENTRAL TEXAS TELEPHONE COOPERATIVE, INC.
IMPORTANT CUSTOMER NOTICE REGARDING
CUSTOMER PROPRIETARY NETWORK INFORMATION
Page 3
CPNI “OPT-OUT” SIGNATURE FORM
By signing this Opt-Out Form, I am informing Central Texas Telephone Cooperative, Inc., its affiliate and
authorized agents, not to sell, trade, or share my CPNI data with any other company or entity outside of CTTC,
or others authorized to represent them, to offer products and services, except as authorized by law.
Date: ___________
Customer Signature: ____________________________________
Customer: _____________________________________________
(please print)
Address: _____________________________________________
_____________________________________________
Telephone Number: _____________________________________
================================================================
System Input Complete
Customer Service Rep: _______________________
Date: ____________________
CENTRAL TEXAS TELEHONE COOPERATIVE, INC.
** Customers need to call the carrier of your choice to set up an account. The carrier should give
you a CIC (carrier identification code) that you need to give to CTTC so we can set up the carrier in
our switch. **
INTERLATA LONG DISTANCE CARRIERS
INTRALATA LONG DISTANCE CARRIERS
QWEST
Business
Residential
1-877-375-4448
1-800-860-2255
QWEST
Business
Residential
1-877-375-4448
1-800-860-2255
NTS
Business
Residential
1-800-588-2222
1-800-588-2222
NTS
Business
Residential
1-800-588-2222
1-800-588-2222
FRONTIER
Business
Residential
1-800-482-4848
1-800-482-4848
FRONTIER
Business
Residential
1-800-482-4848
1-800-482-4848
1-800-727-5555
1-800-444-3333
MCI
Business
Residential
1-800-727-5555
1-800-444-3333
1-800-875-9235
1-800-875-9235
EXCEL
Business
Residential
1-800-875-9235
1-800-875-9235
MCI
Business
Residential
EXCEL
Business
Residential
COAST INTERNATIONAL
Business
1-800-848-2661
Residential
1-800-848-2661
CENTRAL TEXAS TELEPHONE COOP
Business
1-800-535-8904
Residential
1-800-535-8904
CENTRAL TEXAS COMMUNICATIONS
Business
1-800-535-8904
Residential
1-800-535-8904
CENTRAL TEXAS COMMUNICATIONS
Business
1-800-535-8904
Residential
1-800-535-8904
CABLE & WIRELESS
Business
1-888-454-4264
CABLE & WIRELESS
Business
1-888-454-4264
AT&T
Business
Residential
AT&T
Business
Residential
1-800-222-0400
1-800-222-0300
Revised 1/6/15
1-800-222-0400
1-800-222-0300
CENTRAL TEXAS TELEPHONE COOPERATIVE, INC.
PIC FREEZE AUTHORIZATION FORM
(It is Strongly Recommended – but not required – that you authorize a PIC FREEZE)
The purpose of a freeze is to prevent a change in your telephone company without your consent. A freeze is
a protection against “slamming” (switching your telephone company without your permission). You can impose
a freeze on either your local toll or long distance service provider, or both. If you authorize a freeze, you must
contact CENTRAL TEXAS TELEPHONE COOP., INC. at 325-648-2237 or (800) 535-8904 to lift the
freeze before you can change your service provider. You may add or lift a freeze at any time at no charge.
Customer billing name: __________________________________________________
Customer service address: ________________________________________________
City, State, Zip code:_____________________________________________________
Customer mailing address: _______________________________________________
City, State, Zip Code: ____________________________________________________
Telephone number (1) ___________________________________________________
Telephone number (2) ___________________________________________________
Telephone number (3) ___________________________________________________
Customer’s month and year of birth, mother’s maiden name, or last four digits of
The customer’s social security number: ____________________________________
______I authorize a freeze for the telephone number(s) listed above for local toll service.
Current preferred local toll company:____________________________
Customer’s signature:________________________________________
Customer’s printed name:_____________________________________
Date:________________________
______I authorize a freeze for the telephone number(s) listed above for long distance service.
Current preferred long distance company:_________________________
Customer’s signature:_________________________________________
Customer’s printed name:______________________________________
Date:_______________________
Mail or fax this form to: Central Texas Telephone Cooperative, Inc.
P O Box 627
Goldthwaite Texas 76844
Fax Number: 325-938-5319
CENTRAL TEXAS TELEPHONE COOPERATIVE, INC.
CERTIFICATION FOR PER-LINE BLOCKING
I am a customer of Central Texas Telephone Cooperative. I understand that I already have per-call blocking.
However, I certify that I have a compelling need for per-line blocking. I understand I can remove per-line
blocking and go back to per-call blocking at no charge by calling Central Texas Telephone Cooperative
business Office. I understand that my calls to those who have activated Anonymous Call Rejection will not be
completed as dialed unless I call from a different number, payphone or cellular phone, or make a credit card or
operator-assisted call, or dial *82 or 1182 on my phone before dialing the telephone number.
________I request that per-line blocking be installed on my line at no charge.
________I do not want per-line blocking on my line even though my number is unlisted. By choosing this, my
phone number will show up on Caller ID.
I acknowledge that I have read and understand the information about Caller ID. I represent that I am
authorized to request establishment of per-line blocking on the line number identified below.
________________________________________
Area Code/Phone Number (s)
Printed Name as it appears on Customer Bill
Address
City, State, Zip Code
Signature
Date
_____ Residence Number
_____ Business Number
CENTRAL TEXAS TELEPHONE COOPERATIVE, INC.
CENTRAL TEXAS COMMUNICATIONS, INC.
PO Box 627
Goldthwaite, TX 76844
800-535-8904 or 325-648-2237
Automatic Payment Authorization Form - OPTIONAL
Customer Name ______________________________________
Type of Service:
Contact # __________________________
___ Telephone
Account # __________________________
___ Internet
Account # __________________________
Customers may pay their account each month by Credit Card or ACH Bank Deduct. If you choose one of these options, your
bill will be mailed to you on the first of each month and will be noted Credit Card – Do Not Pay or Bank Deduct – Do Not
Pay. Automatic monthly payments are processed between the 5th and 7th day of each month. There is NO CHARGE for these
services.
To authorize an automatic payment option, complete one of the options below and return to our office. By signing below,
I am giving CTTC/CTC authorization to debit my Credit Card or Bank Deduct my account each month for payment of the net
amount on my bill(s). I understand CTTC/CTC will continue to debit my Credit Card or Bank Deduct my account each month
for the service(s) checked above until I provide notice to CTTC/CTC to discontinue this authorization.
CREDIT CARD AUTHORIZATION FORM
Type of Credit Card:
___Visa
Credit Card # ___________________________________
Exp Date _______
___ MasterCard
Credit Card # ___________________________________
Exp Date _______
___ Discover
Credit Card # ___________________________________
Exp Date _______
Name on Card _______________________________________
Authorization Code ____________
(3-digit code on back of card)
Mailing Address ______________________________________
Zip Code ____________________
(Address where you receive your credit card statement)
Signature ___________________________________________
Date _______________________
ACH BANK DEDUCT AUTHORIZATION FORM
(Please Include a voided check)
_____________________________________________
Name of Bank
of
____________________________________
City and State
_____________________________________________
Bank ID Number
____________________________________
Personal Account Number
________________________________________________________
____________________________________
Date
Signature
NON-RESIDENTIAL CUSTOMERS. . . . . . . PLEASE NOTE
Texas Prompt Payment Act Notice
If your organization is a state agency or political subdivision, your organization may
qualify for billing treatment under the Texas Prompt Payment Act. Central Texas
Telephone Cooperative, Inc. requests that you identify yourself as eligible for Texas
Prompt Payment Act billing treatment. You may call our business office at 1-800-5358904 or write to us at PO Box 627, Goldthwaite, TX 76844. If you identify your
organization as eligible for Prompt Payment Act billing treatment, we will request that
you provide a tax exempt certificate or affidavit to document your eligible status. If you
have questions about whether your organization qualifies for billing treatment under the
Texas Prompt Payment Act, please review Texas Government Code Chapter 2251.
Alternatively, you can contact the State Comptroller’s office at 1-800-252-5555 or e-mail
them at WebFileHelp@cpa.state.tx.us.
If you have any questions, please feel free to contact us by one of the above ways.
Central Texas Telephone Cooperative, Inc.
PO Box 627
Goldthwaite, TX 76844
1-800-535-8904
CENTRAL TEXAS TELEPHONE COOPERATIVE, INC.
Privacy Policy
Regarding the Collection and Use of a Customer’s Social Security Number
1.
How your social security number is collected.
We obtain your social security number when you apply for service.
2.
How your social security number is used.
Your social security number is obtained because we will be extending credit to you by billing
you after the services have been provided to you. We also use your social security number
as an additional means to verify your identity and distinguish you from other customers with
the same or similar name and to administer the LITE-UP Texas Program.
3.
How do we protect your social security number?
We are sensitive to your concerns that your social security number might fall into the wrong
hands, which could result in identity theft or general access to your personal information
by unauthorized persons.
Your Application for service, and any other documents containing your social security
number, is filed in a secure location to which only a limited group of authorized personnel
have access. Personnel who receive your Application have strict instructions to
immediately transport such documents to the secure area and to not permit such documents to
remain on desks, in baskets or elsewhere in general work areas where they could be seen by
unauthorized personnel. Personnel are prohibited from copying or in any way duplicating
documents containing your social security number except duplication by instruction of
authorized personnel for an authorized purpose.
Your social security number does not appear in electronic form accessible on our network by
any employees not authorized to have access to your social security numbers. Firewalls,
passwords and other safeguards have been installed in our network to restrict access to your
social security number to those employees so authorized. Employees authorized to have
access to your social security numbers are prohibited from saving your social security
number, in any fashion, on a the hard drive of any laptop or other stand alone computer not
saving data on our network.
We will not include your social security number on any documents, such as monthly
statements, for which it serves no purpose. We need your social security number on file for the
purposes stated but will not use it unnecessarily so as to limit the opportunity for it to be
inadvertently disseminated.
Privacy Policy
Regarding the Collection and Use of a Customer’s Social Security Number
Page 2
All employees who will come in contact with your social security number are provided initial
training before they are permitted to handle any document containing social security numbers
and will be reminded, through periodical updated training, of the importance of protecting the
privacy of social security numbers and our policies which have been designed to insure such
protection, asserting the need to safeguard customers’ social security numbers. Before
discarding any customer records, employees are to shred any portion of the records that contain
a customer's social security number.
4.
Who can access your social security number?
Personnel, or clerical staff who open mail, will have access to documents containing your
social security number.
If your account is turned over for collection purposes and the attorney/collection agency
requests your social security number to assist in collection proceedings, we will provide your
number to them as our agent.
If we receive a subpoena or Court order compelling us to turn your records over to a law
enforcement agency or investigator or to a party in connection with a legal proceeding, then we
will release them, including your social security number, as required by law. If the subpoena
is issued in a civil matter, you should have the opportunity to seek a protective order or to
quash the subpoena to protect the confidentiality of your information.
5.
How will we eventually dispose of your social security number?
Once you terminate service and pay all amounts owed to us on your account, you may
request that we destroy any records containing your social security number. Upon such request,
such documents will be shredded and any electronic records will be permanently deleted.
If no request is received from you after service is terminated and fully paid for, we will retain
your records in accordance with our record retention policy and this privacy policy. If we
elect to destroy your records in accordance with our policy, the records containing your
social security number will be shredded and any electronic records containing your social
security number will be permanently deleted.
Texas Low-Income Telephone Program
Lifeline
Central Texas Telephone Cooperative wants you to know about
discounted rates offered in our area through the
Texas Low-Income Telephone Program.
Every Person in America should have access to affordable
telecommunications service. You may qualify for reduced
rates for these services.
HOW DO I QUALIFY?
If you or someone residing in your household participates in
any one of these programs . . . .
Food Stamps (Supplemental Nutrition Assistance Program)
Medicaid
Children’s Health Insurance Program (CHIP)
Low-Income Energy Assistance
Supplemental Security Income, or
Federal Public Housing Assistance
. . . . You can receive reduced rates. In addition, you may also qualify if
your household annual income is at or below 150% of the federal poverty guidelines.
HOW DO I APPLY?
Contact Lifeline toll-free at (866) 454-8387, or write them at 1779 Wells Branch Parkway, Suite 110B #357, Austin TX 78728-7022, or call Central Texas Telephone Cooperative at
(325) 648-2237 or toll free at (800) 535-8904.
Para preguntas relacionadas a LIFELINE
Texas llame gratis a: 1-866-454-8387.
C e n t r a l Te x a s Te l e p h o n e C o o p e r a t i v e , I n c .
1012 Reilly
Goldthwaite TX 76844
****
208 E. Brown
San Saba TX 76877
Phone: (325) 648-2237
(800) 535-8904
Fax:
(325) 938-5319
Email: cttc@centex.net
“THE HOMETOWN ADVANTAGE”