New Residential Install form Please Fill Out Info Below Is this a Standard or Enhanced install?*StandardEnhancedName* 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 BronzeLouisa Enhanced SilverLouisa Enhanced GoldLouisa Enhanced PlatinumBrookneal/Acorn Special OfferContract Type*One-Year MonthlyOne-Year AnnualMonthly Internet PaymentInstallerSpecial 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 LaborPro-Rated Service to End of MonthAnnual PrepaymentRouter Programming Charge (does not apply if customer purchases router from SCS Broadband)SERVICE SUBTOTALEquipment Charges + 5.3% TaxRouter EquipmentNo Router$65.00 Basic Router$99.00 High-Powered RouterAdditional EquipmentEQUIPMENT SUBTOTALGRAND TOTALDo you wish to receive invoice by email?YesNoInstall Notes
