Louisa Internet sla form Please Fill Out Info Below Name* First Last Email Billing Address* Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Service Plan*Bronze StandardSilver StandardGold StandardPlatinum StandardBronze EnhancedSilver EnhancedGold EnhancedPlatinum EnhancedContract Type*One-Year ContractGrandfathered MonthlyMonthly Internet Payment* Note: All business plans require a Two Year contract agreement. There is no Month to Month option for business plans.InstallerSpecial ConsiderationsCheck the box below if applicable. Internet signal from tower is not optimal; customer was consulted and wants install anyway. Charges Due at SigningService ChargesInstallation LaborPro-Rated Service to End of MonthRouter Programming ChargeSERVICE SUBTOTALEquipment Charges + 5.3% TaxRouter EquipmentNo Router$65.00 Basic Router$99.00 High-Powered RouterAdditional Equipment (Cable/Ditching at $1.00 per foot)EQUIPMENT SUBTOTALGRAND TOTALDo you wish to receive invoice by email?*YesNo
