Forms
Telephone / Video Services
Chibardun Membership form (PDF) Membership form for new telephone service in Almena, Cameron, Dallas, Prairie Farm, Ridgeland & Sand Creek areas.
Request Mosaic Telecom Long Distance.
Fill out this online form to order Mosaic Telecom's Long Distance.
Business Residential
Supersedure form (PDF)
This form is required when a customer wants to transfer the responsibility of their account or
their telephone number to another person.
Supersedure - Residential Supersedure - Business
Permission to Bury (PDF) - If you have a competitors telephone service and would like to switch to Mosaic Telecom's telephone service but are not sure if Mosaic Telecom's lines are buried to your house we will need your permission to bury them.
Request Voice Mail Fill out this online form to order Mosaic Telecom's voice mail service.
Request Calling Features Fill out this online form to order Mosaic Telecom's calling features.
Request Calling Cards Fill out this online form to order Mosaic Telecom's Calling cards.
Request an 800 number Fill out this online form to order Mosaic Telecom's 800 number.
Internet
Supersedure form (PDF) This form is required when a customer wants to transfer the responsibility of their account to another person or business.
Request Spam Filtering Service
Request Anti-Virus Computer Protection Service
Request Wireless Networking Service
Request Dial-up Accelerator Service
Add your web site to our local pages
Submit local news for our Community Web Site This online form is used to submit articles for our Community Web Site.
Trading Center
Submit an item Advertise items you wish to buy, sell or trade with other Mosaic Telecom customers. (You must be a Mosaic Telecom Internet customer to use this service)
Edit an item Make changes to an item you have submitted to the Trading Center.
Other
Request Information If you would like more information on any of products or services submit this form.
Ready Pay Authorization (PDF) Fill out this form to have your monthly bill automatically deducted from your checking or savings account.
Authorization to make account changes (PDF) Complete this form if you would like to give someone that is not listed on your account authorization to make changes to your account.
Register for Mosaic Telecom Classes Sign up for our FREE Mosaic Telecom classes
