New Residential Install form Please Fill Out Info Below Is this a Standard or Enhanced install?* Standard Enhanced Name* First Last Email Billing Address* Street Address City State / Province / Region ZIP / Postal Code Service Plan*Standard CopperStandard BronzeStandard SilverStandard GoldStandard PlatinumEnhanced CopperEnhanced BronzeEnhanced SilverEnhanced GoldEnhanced PlatinumLouisa Standard BronzeLouisa Standard SilverLouisa Standard GoldLouisa Standard PlatinumLouisa Enhanced CopperLouisa Enhanced BronzeLouisa Enhanced SilverLouisa Enhanced GoldLouisa Enhanced PlatinumBrookneal/Acorn Special OfferContract Type*One-Year MonthlyOne-Year AnnualMonthly Internet PaymentInstaller Special Considerations #1Check the box below if applicable. Internet signal from tower is not optimal; customer was consulted and wants install anyway. Special Considerations #2Check the box below if applicable. Due to special location of radio, licensed climber is needed for all maintenance work on radio and cable going into radio. Every climb, regardless of whether radio failure is due to Acts of God or customer action, will be chargeable at normal rate. This shall supersede any and all other service call procedures listed in this document. Charges Due at SigningService ChargesInstallation LaborPlease enter a number from 0 to 5000.Prorated Service to End of MonthPlease enter a number from 0 to 5000.Annual PrepaymentPlease enter a number from 0 to 5000.Router Programming Charge (does not apply if customer purchases router from SCS Broadband)Please enter a number from 0 to 100.SERVICE SUBTOTALEquipment Charges + 5.3% TaxRouter EquipmentNo Router$65.00 Basic Router$99.00 High-Powered RouterAdditional EquipmentPlease enter a number from 0 to 5000.EQUIPMENT SUBTOTALGRAND TOTALDo you wish to receive invoice by email? Yes No Install Notes
