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Mohawk Networks Residential Activation Form

How did you hear about us?
Service Location Information
Do you rent or own this property?  If you rent, we will send you a form to be completed and signed by your landlord before installation can be scheduled
Choose Your Services
Internet service only.  Please choose speed package
Do you need a router from us? 
Additional $9.99 per month
Would you like our Phone Services? $29.99 per month  
* one time activation fee of $13 per line
Do you want your phone number to be UNLISTED?
Additional $7 per month
Would you like 80-Channel Video Service $64.99 
Additional $6.99 per month for more than 2 TV's

Acceptance of Terms & Conditions

"I give Mohawk Networks permission to call/email me and perform an on-site survey if needed."

Your Electronic Signature 
** Your electronic signature is recognized as legally valid and binding, just as your signature is on paper, as per the Electronic Signatures in Global and International Commerce act (ESGICA) of 2000. **
Today's Date
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