FMCTC - Your Total Communications Provider

Order Services Online!

Please select the service(s) you would like to order. You will receive a confirmation e-mail or phone call within 2 business days verifying that these services have been added to your account. If you are adding Telephone, Cable Television, or Internet services for the first time, either as a part of a TELECOM VALUE DEAL, or a la carte, you will be contacted to schedule an installation or to set-up the service. Certain service order and/or installation fees may apply.

Local Telephone
Residential Phone Line

Business Phone Line

Business Phone Line with Key System

*Local rates apply. Price does not include local, county, state taxes or surcharges. (Federal Subscriber Line Charge, Single Line $6.50; Federal Subscriber Line Charge, Multiple Lines $9.20; Emergency County 9-1-1 Services, $1.00/line; Universal Service Fund)

I want to add the Inside Wire Maintenance plan $.50/line/month
(Business Key System Lines not eligible)

I want to add a PIC (Preferred Interexchange Carrier) Freeze to my phone line so my
long distance carrier is not changed without my approval. FREE

Directory Listing: How do you wish to be listed in the phone book? (i.e. John & Suzy Smith)

I would like an additional listing in the phone book $.50/month
How do you wish the additional listing to appear?

I would like to have a Non-Published Listing $1.00/month

I agree to pay a one-time Membership Fee of $5 upon application of new phone service with Farmers Mutual Cooperative Telephone Company. I understand that certain service order and installation fees may apply. REQUIRED

Long Distance
The long distance plan I choose is:

US Just-A-Dime Plan
(10¢ per minute; $3.95/monthly charge applies; 100 minutes FREE, per telephone line, every month)

US Smart Plan
(14¢ per minute; 100 minutes FREE, per telephone line, every month)

I would like a Travel Card (No charge to obtain card. Monthly rate applies)

I would like a Toll-Free Number
(15¢ per minute, $3.00/monthly charge applies, 20 minutes FREE every month)

I understand that I may designate one company as my primary long distance carrier, and I designate FMCTC as that carrier. By choosing a FMCTC long distance plan above, I authorize FMCTC to handle all my long distance calls. I understand that there will be no ‘switching fee’ to switch my long distance carrier to FMCTC Long Distance. REQUIRED

Cable TV
Basic Cable, 55 analog & 17 digital channels $27.25
+Not available in all areas. Available in the towns of Corley, Defiance, Earling, Hancock, Irwin, Jacksonville, Kirkman,
Manilla, Panama, Tennant, Westphalia, and Cresthaven, Ridge Road and Kingwood Lane housing developments

Premium Movie Channels The movie channel(s) I choose is/are:
HBO $10.00/month CINEMAX $9.00/month SHOWTIME $9.00/month

Internet
The Internet access I choose is:

High Speed Internet Access

Dial-up Internet Access $19.95/month

Operating System (Check One)
Macintosh OSX Macintosh OS9 Windows Vista or XP Win9x/Millenium Win2k/NT Linux

Choose Browser Preference For Windows
Microsoft Internet Explorer: 7.0 6.0 5.x Mozilla Safari

Preferred Username (12 character maximum @ fmctc.com)

Mother’s Maiden Name (for password security)

I have viewed and agree to FMCTC’s Acceptable Use Policy REQUIRED

Telecom Value Packages
Select the Telecom Value Package that best suits you.

All-In-One, $96.68*/month
NOTE: Not available in all areas. Available in the towns of Corley, Defiance, Earling, Hancock, Irwin, Jacksonville, Kirkman,
Manilla, Panama, Tennant, Westphalia, and Cresthaven, Ridge Road and Kingwood Lane housing developments

Speed Plus, $69.99*/month

Entertainment Plus, $60.69*/month
NOTE: Not available in all areas. Available in the towns of Corley, Defiance, Earling, Hancock, Irwin, Jacksonville, Kirkman,
Manilla, Panama, Tennant, Westphalia, and Cresthaven, Ridge Road and Kingwood Lane housing developments

Complete Voice, $39.99*/month

*Local telephone service, taxes & surcharges not included in package price

Provide the following information:
In order to receive the 300 minutes of long distance every month, you must subscribe to FMCTC Long Distance. Please check the box below to agree:

Yes, I (the aforementioned name in the contact information of this form) agree to change or keep my long distance carrier as Farmer's Mutual Cooperative Telephone Company (FMCTC) in order to receive 300 minutes of long distance each month as part of my FMCTC Value Deal Package. REQUIRED

In order to qualify for FMCTC Value Deals, you must be a FMCTC local telephone service customer.
Please check the box below to agree:
Yes, I (the aforementioned name in the contact information of this form) agree to change or keep my local telephone service provider as Farmer's Mutual Cooperative Telephone Company (FMCTC) in order to receive the savings offered in my selected FMCTC Value Deal package. REQUIRED

Do you currently subscribe to FMCTC High Speed Internet? Yes No

Do you currently have a FMCTC Wireless Community Phone? Yes No

Questions about your new services? Don't worry.
A FMCTC Representative will contact you soon to go over the details and to verify your choices.

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I authorize FMCTC to charge my account for the services marked above. This shall be in effect upon the receipt and acceptance by Farmers Mutual Cooperative Telephone Company. I certify that I am at least 18 years of age, and that I have proper authority to add, change, or switch services.

Full Name REQUIRED

Company Name, if applicable

Current Phone Number(s) REQUIRED

Street Address REQUIRED

City State Zip REQUIRED

Mailing Address REQUIRED

City State Zip REQUIRED

E-mail address

Signature REQUIRED
Type in your name as it appears above, signifying your signature.

Date REQUIRED

The information you submit will not be distributed to any other parties.
Thank you. We appreciate your business!