Cottage Country Internet High Speed Internet in Cottage Country » 3G Internet – Sign Up Form

3G Internet – Sign Up Form

Account Information

First Name:(required)
Last Name:(required)
Company Name:
Billing Address 1:(required)
Billing Address 2:
Town:(required)
Postal Code:(required)
Email Address:(valid email required)
Day Phone #:(required)
Fax #:

Service Location

Service Address:(required)
Town:(required)
On Site Contact:
On Site Phone#:(required)
GPS Coordinates (if known)
Directions/Comments:

Service/Support Plan

3G Internet Support Services – 1 Year Term
- » $99.95 per month
- » up to 4 Mbits down & up to 512 Kbits up
- » 5 Gigabytes of data transfer per month
- » 4 cents per MB charged for usage over 5GB
- » Equipment Fee - $425
- » Includes indoor wireless router, internal antenna & rental of radio card
- (radio card remains property of CCi)
- - Onsite Installation Available
- - Additional amplifier and/or antennas may be required

Caveats

- * First month's pro-rated service plus first full month's service due on completion of installation.
- ** All prices are subject to federal GST & Ontario PST, applied at time of invoice.

Payment Method

Please select which method you wish to use to pay for your service. We will contact you by phone before installation to obtain specific details.
Automatic Bank Withdrawal
Credit Card (Visa or M/C)

Terms & Conditions

To submit this order form for service from Cottage Country Internet, you must agree to the terms and conditions stated below. Please read them carefully as they impose obligations upon you.
Click here to read terms and conditions
I have read and understand the terms and conditions.
I understand by submitting this form I have signed up for service.

cforms contact form by delicious:days