Apply for Service

Apply for Service

Please complete the information below to Order your complete PC system or Wireless Only service now and send your Installation Service Request. Or Download and Print our Lease Form to send by regular mail.

Items marked with a * are required unless stated otherwise. Your privacy is important to us. Please review our privacy policy.

*Name:

*Email Address:

*Phone:

*Address:

*City:

*State:

*Zip Code:

Unit Information

*Property Manager:

*Unit Number:

Unit Name:

*Unit Phone #:

*Unit Address:

*City:

*State:

*Zip Code:

Installation Details

Requested Date of Installation:

Please note we will make every effort to have your order filled at our next scheduled installation date closest to the date you indicate. Service fulfillment may occur before or after the date that you have selected based on our installation schedule.

Preferred Time:

Please describe any additional details for your order:

Special instructions for furniture or placement of PC in home:

Cable TV

Cable TV w/ Wireless Internet

Phone

wireless only

PC with Flat Panel

*I have read and accept the service Terms and Conditions.

Phone Service Forms - 911 Terms - Letter of Authorization

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