Customer Proprietary Network Information Form

Under the FCC rules governing the use and disclosure of Customer Proprietary Network Information (CPNI), there are certain circumstances under which Farmers Telephone Company/ Heartland Net 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. The password you choose must be at least 6 alphanumeric characters long (ex. Sc02hs). This form will establish a password and back-up question only for purposes of service and account inquiries, including inquiries relating to CPNI. FTC/HN will only be allowed to discuss account information with those listed as an authorized user on the account and carrying a photo ID. Adding an authorized user does not mean that their name(s) will show up on the bill, but only that these persons will be allowed to discuss CPNI with our company representatives.
Question: What is your favorite color?
Question: What is your favorite color?
Adding Authorized Users to Add to Account(Required)
Please enter User(s) full legal name(s). To add more users click the + button to the right.

Signature

IMPORTANT: By signing below, the customer is providing the company with express, written approval to use the above password and back-up question before providing any information regarding service(s) and account inquiries made by the account owner or designated account users. This approval includes responses to inquiries related to the customer’s services including Customer Proprietary Network Information. By signing below, the customer is expressly requesting that the company share certain account and call detail information, including Customer Proprietary Network Information, with authorized account users and is authorizing the company to share such information with authorized users as necessary to address service and account inquiries initiated by the account owner or any authorized user.
Account Owner(s) Name(Required)
If there is more than one account owner, please click the + button to the right to add more names.
Contact Email(Required)
MM slash DD slash YYYY