| Please fax to 877-441-2368 |
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| Internet 2000
Wireless Commitment Form |
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| Customer name |
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| Address |
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| City/ZIP |
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| Phone number |
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| Circle appropriate :
Plan, Monthly Service and Install amount |
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| Residential Plan |
Business Plan |
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| Monthly service |
384K/384K |
$39.95 |
384K/384K |
$60.00 |
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| 512K/384K |
$50.00 |
512K/384K |
$70.00 |
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1.0M/384K |
$60.00 |
1.0M/384K |
$90.00 |
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| Setup |
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| 12 month
commitment- |
Basic setup =$99 |
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Month to month commitment- |
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Basic
setup =$299 |
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| Installation |
Estimated installation due to your location |
Up to $______ |
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| *In
the event of early termination, customers choosing a 12 month commitment will
be charged the sum of the remaining months fee's, less $17.50 per month. |
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| The
above installation cost is based on standard indoor installation which
includes an antenna, radio, cable and computer setup. Does not include network interface card,
multiple computer networking, firewall or other equipment installation. If an
indoor installation will not provide sufficient radio signal strength, a
quote for the additional cost of an outdoor installation will be provided at
no charge. |
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| The wireless radio and antenna equipment provided for service
usage shall remain the property of Internet 2000. Upon termination of
service, the customer is responsible for return of equipment to Internet 2000
or will be charged $485 for radio and $65 for antenna. |
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| The above party, wishes to subscribe to the Internet 2000
wireless Internet service if the service is available at this location. Payment for basic setup and first month of
service due on completion of Installation. If Internet 2000 is unable to meet
the above terms then the above party is released from any obligation to
accept service or installation. |
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| Customer Signature |
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Date: |
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(Office Use) |
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| Equipment number |
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| IP address |
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Antenna |
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| Date activated |
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Signal |
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