Fiber Sign-Up Form

* Required Fields
* Select Your County: ----- Select County ----- Chelan County Grant County * Type of Service: ----------- Select Service ----------- Chelan County Asymmetrical 3Mb/384k -- $34.95/month Chelan County Asymmetrical 6Mb/384k -- $59.95/month Chelan County Asymmetrical 10Mb/384k -- $79.95 month Chelan County Symmetrical 3Mb/3Mb --$59.95 month Chelan County Symmetrical 6Mb/6Mb -- $119.00 month Chean County Co Location CTC center $20.00 per U of rack space Grant County Asymmetrical 3Mb/384 Residential-- $39.95 month Grant County Asymmetrical 3Mb/384 Business -- $49.95 month Grant County Asymmetrical 10Mb/384 -- $79.95 month Grant County Symmetrical 3Mb/3Mb -- $69.95 month Grant County Symmetrical 6Mb/6Mb -- $129.95 month
Account Information
*First Name: *Last Name:   Company:
Location Information *Connection Address:   Mailing Address: *City: *Zip Code: *Phone:   Cellular Phone: *Email Address:
System Information
* Do you want to rent a Fiber Router or purchase your own?	----- Select ----- Rent -- $5/month Purchase Own
* What is your Operating System?	----- Select ----- Windows 95 Windows 98 Windows ME Windows NT Windows 2000 Windows XP Macintosh Linux Other
* Do you have a network card?	----- Select ----- Yes No I Do not Know
* Do you have an available USB Port?	----- Select ----- Yes No I Do not Know
* Do you have an available PCI Slot?	----- Select ----- Yes No I Do not Know
Questions/Comments: