Internet Service Application

"*" indicates required fields

Company or Organization Name*

Phone*

Primary Contact Name*

First Last

Email*

Enter Email Confirm Email

UBI Number*

Job Name

Name of end user for service if different from company or contact requesting service

Broadband Service Requested*

Select product from list below

1 Gig/1 Gig

Other

Service Address*

location where utilities are installed and metered

Street Address and/or unit # City ZIP / Postal Code

Billing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Secondary Contact for Account

Do you wish to list or remove any one else as a representative for your account? This person can access account data and pay bills.

Yes

Secondary Contact Name

Add or remove a Secondary Contact by entering their name here.

First Last

Secondary Contact Email

Secondary Contact Phone

Comments or Questions?

Please add any additional comments or requests in the space below.

Read the District's Internet Service Policies Link to Internet Service Policies and Rates Read the Full Customer Service Policy Online Link to Customer Service Policy Read the Open Access Network Broadband Service Policies Link to Open Access Service Policy

Signature*

CAPTCHA

Name

This field is for validation purposes and should be left unchanged.