Locally owned wireless broadband internet.

DGF

Type of Internet Service

VOIP?

Package Level

Tower

Name

First Name

Last Name

Phone Number

Alternate Contact Name

First Name

Last Name

Alternate Contact Phone Number

Physical Address

City

Zip

Drivers License or SSN#

Information required for billing purposes.

What is your DOB?

DOB of account holder for billing purposes and to confirm that they are over 18.

Rent or Own Dwelling?

Number of Stories? (Do we need an extension ladder?)

What Streaming Services do you use?

Netflix

Hulu

Amazon Prime

Online Gaming (Xbox, Playstation, etc.)

None

How many People/Devices access the internet at the same time?

How do you want to receive your bill?

(Note that first bill will be sent via postal mail)

Are you interested in automatic bill payment?

No Show Policy

If you no show an appointment, you will be required to pay $89.99 up front to get a new appointment. After a no show, this fee in non-refundable. You must call us to cancel or reschedule before your appointment time.

Yes, they have been informed

Do you have an Alternate Billing Address?

Scheduled Install Date

Did anyone refer you to us?

Representative

Additional Notes