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Personal Information First Name: Last Name: Email: Phone: Unit/Apt: Address: City: Postal Code:

Internet Plans

25 Mbps ($35/mo) 25 Mbps Yearly (waive activation fees) 30 Mbps ($40/mo) 30 Mbps Yearly (waive activation fees) 50 Mbps ($45/mo) 50 Mbps Yearly (waive activation fees) 100 Mbps ($55/mo) 100 Mbps Yearly (waive activation fees) 250 Mbps ($70/mo) 250 Mbps Yearly (waive activation fees) 500 Mbps ($80/mo) 500 Mbps Yearly (waive activation fees) 1000 Mbps ($90/mo) 1000 Mbps Yearly (waive activation fees)

Add Home Phone Service ($8.99/mo)

Assign New Number Port Existing Number

TV Packages Skip TV Basic Yearly ($80 Per Year + activation fee=$25) Basic ($12/mo + activation fee=$25) Sports ($24/mo + activation fee=$25) Premium ($36/mo + activation fee=$25)

Modem Type Monthly Rental ($5/mo + $30 refundable deposit) Purchase Modem ($186) and add Wifi Router ($30 refundable deposit) I have my own Modem and Router

Modem Model: Modem Serial Number: MAC Address:

Installation Appointment

Suggest up to three days and time slots. Please allow for at least 2 weeks to complete the installation.Installations can be done on weekdays and weekends. Weekend installations are available.

Installation Date: Preferred Time Slot:

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Payment Information

To complete your signup and begin the activation of your services, a valid payment method is required. Your initial payment will cover installation fees (if applicable) and the first month of service. Activation will not start until payment is successfully processed.

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Total Due: $0.00

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