ISP Application

Company Name(Required)

Application Type(Required)

New Applicant

Renewing Applicant

Has Any of your Company or Contact information changed in the last year?(Required)

If none of your contact info has changed, you do not need to fill out the contact fields below

Yes

Unsure

Website

Company Email

Company Phone

UBI Number(Required)

Authorized Representative (AR)

First Last

AR Email

(AR) Phone

Additional Contacts?

List any other contacts you'd like us to be have access to regarding your work on our network.

Yes

Additional Contact (AC) Name

First Last

AC Email

AC Phone

24/7 Call Number

Please provide the number you give to End Users for 24/7 365 technical support

Number of Current Customers

Served by your business and network. Approximations are fine.

Please enter a number greater than or equal to 0.

Areas of Operation(Required)

List all WA counties or US states that your business operates in.

References(Required)

Please provide names and email or phone contacts of customers or colleagues that can attest to the quality of your service.

Reference 1

Reference 2

Reference 3

ARIN Registration?(Required)

Does your business have a BGP Autonomous System Number and IP space registered with ARIN? If not what other system do you use?

Yes

Other

Core Network Description(Required)

Provide a brief description of your core network and its capacity to deliver service to JPUD end users. Alternatively, you can upload a brief narrative along with your network diagram.

Upload Core Network Diagram(Required)

Please provide an illustration of your network components.

Drop files here or

Accepted file types: jpg, png, pdf, doc, xls, heic, Max. file size: 15 MB, Max. files: 5.

Proof of Insurance(s)(Required)

See Open Access Network Broadband Service Policies for specific insurance requirements.

Drop files here or

Accepted file types: pdf, jpg, png, doc, tiff, heic, Max. file size: 15 MB, Max. files: 5.

Signature(Required)

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Comments

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

ISP Application

Broadband Service Policies

ISP Service Request

Broadband Rate Sheet