IMPORTANT NOTICE REGARDING YOUR ACCOUNT

Tele-Media Solutions changes its service offerings from time to time and makes available new features and services which may enhance and augment the services to which you are already subscribed. In order for us to determine which customers may benefit from the new service and enhancements, we will use information about your account that is maintained in our database, legally referred to as Customer Proprietary Network Information (CPNI) unless you restrict that use in the manner described below. CPNI includes information such as the long distance carrier and calling plan you use and the associated charges for those plans. Use of this data allows Tele-Media Solutions to tailor our service offerings to your individual needs.

CPNI data will be used by Tele-Media Solutions for this purpose only. Tele-Media Solutions will not share this data with any outside source except as necessary and when required to provide the service(s) to which you are already subscribed, and when legally compelled.

Your rights to confidentiality of your account information and the restricted use of CPNI data are protected under federal law and we have the responsibility to protect your data. To restrict the use of your CPNI data, you will need to call the business office at (812) 967-3171 during regular business hours, email us at business.office@tele-mediasolutions.coop, or complete the form below and return to our office at PO Box 9, Pekin, IN 47165 within 30 days of your receipt of this notice to request that we not utilize your CPNI data to inform you of newly available features and services. Your denial of approval for Tele-Media Solutions to use this data will not affect the provision of any services to which you subscribe. Your approval or denial of approval for the use of CPNI outside of the service to which you already subscribe will remain valid until you revoke or limit the approval or denial.

I hereby request that Tele-Media Solutions not utilize the CPNI data for my account(s) except when required to provide the service to which I am already subscribed or when legally compelled.

Name
Account Number

Address                                                 City
Zip

Telephone Number(s)

This authorization is to remain in effect until Tele-Media Solutions has received written notice from me of its termination in such a manner as to afford Tele-Media Solutions a reasonable opportunity to take action. By signing, I attest that I am authorized to make changes on this account.

Signature                                                 Date