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Customer Registration Form
Pierce Telephone Company, Incorporated is proud to have served our customers for over 55 years and we'll be here in the future. We are an aggressive leader in providing communication services and exceptional customer service. We are committed to accomplishing this in a prompt, efficient, and professional manner.

Below you will find an application with information concerning the services and features that Pierce Telephone Co., Inc. offers. Bundle High-Speed Internet, Long Distance, and Local Telephone Service and save every month! In addition, you get to choose discounted calling features and the number of Pierce Long Distance minutes that are right for you.

If you have any questions, please call or email our office and we'd be happy to go through it with you. Please submit the application with a copy of your driver's license and current contact information. We do reserve the right to charge a deposit. This is a minimum of $50.00 for local service only and $100.00 with Long Distance and or Internet Service. If you can provide a current, quality letter of credit from your previous telephone service provider, the deposit may be waived.

You will receive your billing statement on the 1st of every month and it is due by the 20th. Payments may be made at the Pierce office either in person or by using our drop box. Customers may also pay by mail or with automatic monthly payments through their bank or credit card, Hoskins customers may also pay at Elkhorn Valley Bank (Hoskins).

In addition, Pierce Telephone Co., Inc. is also a Dell Certified Partner offering desktop computers and laptops on hand or is able to customize a computer to fit your needs. We are also PTCMobile which provides Nationwide Cellular Service.

It is the intention of Pierce Telephone Co., Inc. to be in full compliance with provisions of Title VI of the Civil Rights Act of 1964 and does not discriminate against sex, race, color or national origin in hiring, promotions or in the class of service rendered.

Our employees are committed to bringing you the best for all your telecommunications, long distance, and internet needs.

Download 'Mail-In' Application and CPNI Form


Things you will need to complete this form:

  • Copy of Drivers License or Photo ID to upload (i.e. - scanned image file).
  • Social Security number.
  • Must be at least 18 years old.
  • Deposit or Letter of Credit is required.
    Call: (888) 329-6225
    - or -
    Send in payment to:
    Pierce Telephone Co., Inc.
    112 S. 5th St.
    P.O. Box 113
    Pierce, NE 68767
Customer Registration Form
Section I: Customer Information
Date Ready for Service:     
Personal Pin for Identification:   (Required - Enter a 4 Digit Pin.)
Customer Information (Required).
Customer First Name:     Middle Initial:    Last Name: 
Social Security #: 
Phone #:     Cellular #:    Email Address: 
Billing Address (Required)
Billing Address: 
Billing City: 
Billing St: 
Billing Zip: 
Physical Address (If different)
Address: 
City: 
St: 
Zip: 
Spouse Information (If applicable).
Spouse First Name:     Middle Initial:    Last Name: 
Social Security #: 
Others Authorized Information (If applicable).
Other First Name:     Middle Initial:    Last Name: 
Employer Information (Required).
Employer:  Employer's Phone: 
Employer:  Employer's Phone: 
Automatic Monthly Payments (Optional - if payment is to be directly withdrawn each month).
Automatic payments are available and are set up via contacting Pierce Telephone Company.
Customer Proprietary Network Information (CPNI) (Optional).

Check if you want to opt out.

 
Section II: Plan (Choose 1 of the 3 below)
1. Bundled Service.
Choose Residential Bundles* Choose 2 or more Calling Features Choose Pierce Long Distance Plan**
LD = Long Distance. Installation Fee $20.00
Simply Basic - $20.95 + LD Plan
Unlimited Local Phone
Choice of 2 Calling Features
Choice of Pierce Long Distance Plan
High Speed Plus- $50.95 + LD Plan
Unlimited Local Phone
Choice of 2 Calling Features
Unlimited High-Speed Internet
Choice of Pierce Long Distance Plan
In-Home Business- $53.95 + LD Plan
Unlimited Local Phone
Choice of 2 Calling Features
Unlimited High-Speed Internet
Choice of Pierce Long Distance Plan
Simply Unlimited- $95.95
Unlimited Local Phone
Choice of 2 Calling Features
Unlimited High-Speed Internet
Unlimited Pierce Long Distance Plan
Additional Calling Features = $1.00 each.
Auto Recall
Auto Call Back
Call Waiting
Caller ID (Number Only)
Calling Name (Name Only)
Distinctive Ring
Speed Calling
Selective Call Acceptance
Selective Call Forwarding
Selective Call Rejection
Three-Way Calling
Combine multiple Long Distance Plans to get a package that is right for you.
Pierce Simple 50 $6.00
Pierce Simple 100 $10.00
Pierce Simple 200 $18.00
Pierce Simple 500 $40.00
Toll Free Number $0.14 / min.

Additional Savings - Bundle Add-Ons
Voicemail $1.50
900 Block FREE
Collect Call Block FREE
Preferred Toll Carrier Freeze FREE
2. A La Carte.
Local Telephone Service Calling Features Long Distance Service
Telephone Line - Installation Fee $20.00.
Residential
• Interstate Access.
• Dual Party Relay Surcharge for the Hearing Impaired.
• ARC Charge.
$17.50
$6.50
$0.04
 
$1.00
Business
• Interstate Access & ARC Charge (Single-Line).
• Interstate Access & ARC Charge (Multi-Line).
• Dual Party Relay Surcharge for the Hearing Impaired.
• E911.
$20.45
$7.00
 
$10.20
 
$0.04
 
$1.00

Toll Restriction
Total Toll Restriction
Required for Local Service Only.
Restricts 1+ and 0+ dialed calls. Can still call 911 locally, and toll free numbers.
$1.00
1+ Restriction
Restricts 1+ dialed calls.
$1.00
Per Call Restriction
Requires a pin # to make 1+ and 0+ dialed calls. Per call also requires a $10 activation fee.
$5.00
Call Waiting $2.50
Caller ID (Number Only) $1.50
Calling Name (Name Only) $3.00
Calling Forward $1.50
Calling Forward Busy $1.50
Calling Forward No Answer $1.50
Calling Forward Remote Access $1.50
Distinctive Ring $4.00
Speed Calling 8 $1.75
Speed Calling 30 $3.50
Three-Way Calling $1.50
Warm Line $1.50

Advanced Calling Features
Auto Call Back $2.50
Auto Recall $2.50
Selective Call Acceptance $2.50
Selective Call Forwarding $2.50
Selective Call Rejection $2.50
Combine multiple Long Distance Plans to get a package that is right for you.
Pierce Simple 50 $6.00
Pierce Simple 100 $10.00
Pierce Simple 200 $18.00
Pierce Simple 500 $40.00
Toll Free Number $0.14 / min.

Additional Options
Voicemail $4.00
  Contact for specialized Voicemail.
900 Block FREE
Collect Call Block FREE
Preferred Toll Carrier Freeze FREE
3. High-Speed Internet ONLY.
High-Speed DSL without any other services. $57.60


 
Section III: Internet Service
DSL .
High-Speed DSL ONLY $57.60
Installation
12-Month Minimum Contract FREE
Month-to-Month Service Contract $281.00 (1-time)
Features
A Username and Password must be chosen to authenticate in our server. If you would like your Username to also be your email address
(i.e. - username@ptcnet.net) please check the box beside "Username".
Username:     Password:
Multiple Email Accounts FREE
Junk Email Filtering Service included with each email account. FREE for first 2 months
  $1.00/month after 2 month period if not canceled.
Web Directory Storage FREE
Web Site Domain Call
Standard Equiptment***
Wireless DSL Modem / N Router $49.50 (1-time)
Wireless DSL Modem / N Router Rental $10.00
Surge Protector (Optional) $24.99 (1-time)
Extended Equiptment***
Line Conditioning (Required - Outside equipment takes place of modem) $49.50 (1-time)
Wireless N Router $50.00 (1-time)
Surge Protector (Optional) $63.50 (1-time)
Terms of Use Agreement (Required)
As a customer of PTCNET's digital subscriber line (DSL) service, you must agree to our terms of use. These terms apply to all PTCNET subscribers who use full-time or part-time direct connections to our system, including, without limitation, DSL Service.
I understand and agree to these terms.
 
 
Section IV: Other Services
Directory Services.
Published in 411 & Phone Directory FREE
  Name to Appear: (i.e. - John J. Smith)
Inside Wiring Maintance Agreement.
Inside Wiring Maintenance Plan $1.00
  You are responsible for the repair and maintenance for your inside wiring. Without the plan, a minimum fee of $45 plus materials applies if a repair is needed. This plan does not cover trouble with customer owned equipment.  
PTC Mobile Nationwide Cellular Service.

Check out our PTC Mobile information.

Yes, please contact me about a PTC Mobile Plan.
Copy of Driver's Licensed or Photo ID (Required).
Upload file:
 
Install Charge Applies. Submitting this form indicates an electronic signature and will start your registration with PTC. In order to better serve you, feel free to call customer service with any questions at (402)-329-6225.
Type text: Captcha Image Different Image


 I hereby agree and authorize all information in this form for Pierce Telephone Co., Inc. use only.
 
*All rates do not include Tax, Universal Service, FCC charges, E911 charges, DSL, one-time charges or equipment, feature activation charges, or other toll calls. Discounts take effect on the first day of the next billing cycle. Customer must maintain all products listed in selected bundle to qualify for the monthly discount.

** Customer must be subscribed to Pierce Long Distance for both in-state and out-state carriers to qualify. Rates are figured at 10 cents/minute out-state and 15 cents/minute in-state after plan minutes.

*** Standard vs. Extended DSL - Standard DSL constitutes a residence within 3 miles of Pierce with exceptions. Outside areas belong to Extended DSL and are subject to higher fees. Call to see what area you are in.
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