Internet Sign Up Form ____________________________________________________________________________________ HiddenContract Sign Date* MM slash DD slash YYYY I am already a Customer No, I am a NEW Customer When do you want service to start?*If you want services as soon as possible - just pick todays' date.Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Choose your Internet Plan* "CheaperNET" - Unlimited 25 - $33/month Unlimited 75 - $73/month Unlimited 150 - $83/month Unlimited 300 - $93/month * $100 activation fee, $9.95/month equipment fee ** Bundle-it and SAVE! Get a $25 dollar credit if you add Internet to your power or gas plan with us!Your DetailsPrimary Contact* First Last Your Email Address* Primary Phone Number* Where you do need internet installed?House, Street, City, Postal Code* Terms and ConditionsI have read and agree to the Terms and Conditions I agree to these terms and conditions:* Yes CommentsDo you have any additional comments or questions?EG. Did you want your modem sent to a different address? PaymentThank you for completing our online enrolment form. Since payments for our accounts are completed by pre-authorized bank withdrawal, we will need a copy of your bank details. Click the following button to finish the application by setting up your pre authorized payment information. Please note that your application will not be processed until we receive your payment information.NameThis field is for validation purposes and should be left unchanged.