LTE Registration Page 2 — Etex - Internet, Phone, & Digital TV

Auto-Draft Payment Option

Check the box if you are interested in Auto-draft Payments. By checking yes you will receive a $1 monthly credit to your account.

Yes
No

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Full Name*

First Last

Email*

Phone Number*

SSN*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Select a payment type*

If you have already signed a 24 month TV service contract, then you may select option 3

Auto Bank Draft
Auto Credit Card Draft

Bank Account Information

Bank Name*

Bank Routing Number*

Bank Account Number*

Is this account in your name?*

Yes
No

Account Holder's Name*

First Last

Account Holder's DL#*

Driver's License number

Credit Card Information

Credit Card Type*

Credit Card Number*

Exp. Date*

MM/YYYY or MM/DD/YYYY

Security Code*

Full Name on Card*

Terms & Conditions

Digital Signature

Etex Telephone Cooperative offers e-signature on service subscription to provide more convenient customer service when ordering from the Etex family of services. In order to receive the service desired, the customer establishes proof of identity such as photo ID (specify practices allowed i.e. SS#, bank account) and signature can be accepted using the following electronic signing process. By indicating in the checkbox or signature line and date provided, you are agreeing to the terms and conditions of service/or family of services that are displayed in the service description presented in this contract.

Customer Privacy

You electronic signature and related subscriptions are considered proprietary information known as Customer Proprietary Network Information. The Cooperative does not sell, share or disclose your CPNI without written permission. Provision of Federal Trade Commission, Federal Communications Commission, and Texas Business Code governs these practices and are not exclusive to consumer protections.

Paper Copy

A paper copy of the agreement or subscription that you have signed using the electronic signature can be provided upon customer request. The customer may elect to not use e-signature for service ordering and instead visit our business Office during operating hours.

I understand the following about Automatic Bank Draft

My checking account will be drafted on the 12th or following business day if the 12th falls on a weekend or holiday for customers on bill cycle one. My checking account will be drafted on the 20th or following business day if the 20th falls on a weekend or holiday for customers on bill cycle two.
I have the right to stop Payment of the draft by notifying Etex within five days of receiving my statement.
A $25 fee will be charged to my account for each draft returned for non-sufficient funds. If two drafts are returned, I will be excluded from the automatic draft payment program.
Both my bank and Etex reserve the right to terminate this draft payment plan and/or my participation therein. At any time, I may elect to discontinue my enrollment by providing written notice to Etex.

I understand the following about Automatic Credit Card Draft

My credit card will be charged on the 12th or 20th of each month.
I have the right to stop charging my card by notifying Etex within five days of receiving my statement.
Both my credit card company and Etex reserve the right to terminate this payment plan and/or my participation therein. At any time, I may elect to discontinue my enrollment by providing written notice to Etex.

I understand the following about Credit Card on File for Service Contract

I understand my credit card on file will be charged for any early termination fees due to breach of contract.
Etex reserves the right to break the charges for any ETF fees into multiple transactions due to some account limitations.
It is my responsibility to notify Etex if my credit card account number changes or my card expires.

Agree to Terms*

I agree to the conditions listed on this document and do provide Etex Telephone Coop with my e-signature. Click here to read our Digital Signature Terms & Conditions.

I Agree

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Phone

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Autodraft Signup - LTE Broadband

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Bank Account Information

Credit Card Information

Terms & Conditions

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