* Indicates Required Fields.

Community Name:

*Home Phone #:

Email Address:

*Full Name:

Cell Phone #:

*Driver's License #:

*Best Time to Call:

*Address:

Choose:

# of converters:

MiniMax — $4

HD Set-Top — $10

HD-DVR — $15

Tivo HD DVR — $18

Choose:

Modems:

Standard Modem:



Wireless Modem:




NOTE: Purchasing a modem is a one-time charge. Renting will be a monthly charge.

Choose:





NOTE: Digital Phone Equipment Is Included in the Phone Package Price





Make sure you tell me about any specials you have when you call.

Specialty Packages:

Premium Packages:





Premium Package Pricing:

1st Premium — $14

2nd Premium — $11

3rd Premium — $9

4th Premium — $7

NOTE: (If HBO, add $2)

foreign language:

Installation:



Additional Outlet:

# of Pre-wired Outlets

# of New Outlets

NOTE: Standard Installation includes activation of 2 prewired outlets.


You MUST read the Terms & Conditions and Acceptable Use Policy
and then check the box below to accept before submitting your order.

I Accept the Terms & Conditions and Acceptable Use Policy