Kalona Interest Form Sign up here to help bring Fiber to the Home services to your neighborhood! First Name * Last Name * Email Address (All correspondence including your service agreement, installation scheduler, and billing information will be sent to this email address.) * Service Address City State Zip Is your Mailing Address different than your Service Address? Yes, they are different. No, they are the same. Mailing Street Address Mailing City Mailing State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Mailing Zip Primary Phone Number Secondary Phone Number Who is your current Internet Provider? Mediacom Windstream Cloudburst 9 Wireless/Satellite Provider Other Who is your current Phone Provider? Mediacom Windstream Who is your current TV Provider? DISH Other KCTC Service Are you interested in? Phone Internet TV Security Cameras Phone Systems IT Support Services How did you hear about us? Website Web Ad Email Direct Mail (letter/postcard) Yard Sign Vehicle Decal Radio Ad Radio Talk Show TV Ad TV News Story Newspaper Ad Newspaper Article A Friend Door to Door Salesperson Facebook Event Other Door to Door Salesperson Friend's name Are you currently in a contract? Yes No Date Contract Ends I would like KCTC Fiber to come to my neighborhood faster and you can contact me to get my neighbors to also commit to KCTC services? * Yes! Not at this time. Are you ready to pay your pre-registration payment? Yes, I would like to pay via PayPal/Credit Card Yes, I would like to pay via sending in Cash/Check Not a this time. Would you like a yard sign in your yard? Yes No Questions? Comments? reCAPTCHA Submit
