Hoosier Hills Credit Union - Kiva Application


HHCU Customer Information Form
Directions: To begin your Internet subscription, please fill out, print, and sign this form, then fax or send it to the above address. Don't forget to complete Step 4.
Name
Address
City, State, Zip
Phone
Step 1: Please choose the type of account you want to establish
Availablility This service is a toll free local call for the residents of Lawrence County and parts of Orange County including Orleans and Paoli. This includes the following telephone prefixes: 275, 277, 278, 279, 834, 849, 865 and 723. It is accessible from other prefixes, but long distance phone charges will apply.
HHCU Residential Dial-Up Account ($20.95/month) A Residential Dial-Up Account is for non-commercial purposes only. HHCU Basic Business Dial-Up Account ($28.95/month) A Basic Business Account is any account whose username is a direct representation of a business name or an organization; or any account whose billing or service address is a business; or any account who advertises or attempts to profit from the use of said account.
Above rates are available ONLY if you allow Hoosier Hills Credit Union to debit your checking or savings account. If you prefer other means of payment, please contact Kiva Networking directly at 800-819-8143.
Step 2: Authorize direct debit from your Hoosier Hills Credit Union Account
Hoosier Hills Credit Union Debit Information: I (we) hereby authorize Hoosier Hills Credit Union to initiate debit entries to my (our) account. My (our) member number is . The debit date will be the 25th of each month or the next business day if the 25th falls on a non-business day. THe authority to debit the account is to remain in full force until Hoosier Hills Credit Union has received written notification from me (or either of us) of its termination in such time and in such a manner as to afford Hoosier Hills Credit Union a reasonable opportunity to act on it.
Step 3: General Disclaimer and Warning for Internet Data Content and Kiva Policies.
Please read the info below in its entirety, print completed form, and sign below.
You are about to enter the world's largest electronic community. Information can be accessed across international boundaries, as well as corporate and private areas. These sources of data and files belong to and are as such regulated (or not regulated) by every kind of organization and entity imaginable such as companies, universities, governments, and people. Some of these data and file resources may contain language, graphic images, or potentially dangerous file characteristics (such as viruses) that some individuals may consider to be offensive or viewable by adults only. The contents of these data and file resources are the responsibility of their providers only, and we do not endorse them in any way and hereby disclaim any and all liability for their attributes and content. Parents with children who may have access to various Internet facilities are advised to regulate their access to supervised activities. We reserve the right to at any time discontinue a user account for any user who does not comply with the respective acceptable use policies of our organization, or the organizations of the Internet communities at large. If you do not understand these statements in any way, or wish further clarification, feel free to call Kiva management (1-800-819-8143) at any time for a verbal description of our policies regarding Internet content. Please further review the policies on our web site that apply to your Kiva service: Acceptable Use Policy -- http://www.kiva.net/customers/policies/acceptableuse.phtml Billing Policy -- http://www.kiva.net/customers/policies/billing.phtml Privacy Statement -- http://www.kiva.net/customers/policies/privacy.phtml

_____________________________________________ Print name(s) of Account Holder(s)	______________________________________________ Signature(s) of Account Holder(s)
_____________________________________________ Print Name(s) of Account Holder(s)	______________________________________________ Signature(s) of Account Holder(s)
Step 4: Complete registration by calling Kiva Networking at 1-800-819-8143, option 1
You must speak with the Kiva Billing Department to complete your Internet account registration. The Kiva representative will ask preliminary account set-up information (including your Credit Union account number) and process your order. Furthermore, Kiva will also be your point of contact for any billing or technical questions that may arise.

Click for HHCU's Privacy Policy.