Mohawk Networks Fiber-to-the-Home Activation Form Business Services Please complete this form to sign up for Business Class Fiber-to-the-Home Services with Mohawk Networks. How did you hear about us? Please choose one: How did you hear about us? *Chamber of CommerceColleagueDoor HangerFamilyFriendFlyerGoogle AdInternet SearchLive Event: Business Leader's BreakfastLive Event: Cheese FestLive Event: County FairLive Event: Meet & GreetLive Event: Town MeetingNewspaperPostcardRadioSocial Media: FacebookSocial Media: Google+Social Media: InstagramSocial Media: LinkedInSocial Media: TwitterSocial Media: YouTubeTelevisionYard Sign Service Location Information (where you want to have Internet service) Phone Number Type: Please select oneWorkHomeMobileOther Type of Building: Home BusinessBusiness ComplexOffice BuildingStand-Alone BuildingOther If you chose "Other", please describe your place of business below: Do you rent or own this property? RentOwn ** IMPORTANT: If you rent your home, we will send you a form to be completed and signed by your landlord BEFORE we can schedule your installation. ** Billing Information (where you want your bill to be mailed) If you choose to become a customer, will your Billing Address the same as your Service Address you typed above? YESNO If you selected NO, please give your billing address below: Internet Service Which speed would you like? 15 Mbps Download 5 Mbps Upload - $119.99/month USD25 Mbps Download 10 Mbps Upload - $199.99/month USD50 Mbps Download 20 Mbps Upload - $399.99/month USD75 Mbps Download 35 Mbps Upload - $599.99/month USD100 Mbps Download 50 Mbps Upload - $799.99/month USD Do you want a Dedicated IP Address? Yes -- $30.00 additional per month USDNo Do you need a router device? Yes -- $9.99 additional per month USDNo -- I have my own or will be purchasing one from a retailer of my choice. Voice Services Do you want a Standard Business Phone Line (with unlimited long distance, full-featured, with voicemail)? YES -- $33.99 additional per month (and a one-time activation fee of $20.00 per line)NO -- I am not interested in voice services at this time. If you chose YES to have a Standard Business Phone Line, do you want us to port your old number over or do you want a new phone number? Please port my number over. -- $5.00 one-time feeI would like a new phone number. Do you want your phone number to be unlisted? YES -- $7.00 per line per monthNO -- I would like my number to be listed. If porting your number over, please type your phone number (including area code) and current provider in the space below: Are you interested in advanced voice features, such as SIP/VSX trunking, auto attendant, Fax to Email, Hosted PBX, and more? YES -- Please have a voice specialist call me to discuss a customized voice solution for my business. NO Video Services Do you want our 80-Channel Video Service (with a variety of premium channels included)? YES -- $74.99 additional per month (1 television)NO If you would like additional televisions to be included with your service, please indicate the number in the box below. Additional televisions are $9.99 per month per television. Other Fees You Need to Know About Disconnection Fee (for Non-Payment): $25.00 per occurrence On-Site Service Call Fee: $39.99 per service call (Does not apply if there are issues with our equipment or service and are applied at the discretion of the technician.) There are additional fees for underground work or installation of new fiber, which may result in additional fees. An estimate of fees necessary for your location will be provided on a case-by-case basis as determined by the site survey. 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 Submit
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