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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 Plans
Residential - Month to Month
» $49.95 per month
» up to 3 Mb/s down & up to 1.5 Mb/s up
» 30GB of data transfer per month
Installation Pricing:
• $249 - Limited Time Special >>
Click here for details!
<<
Seasonal Residential
» Service for 6 continuous months
» $440 per year
» up to 1.5 Mb/s down & up to 512 Kb/s up
» 10GB of data transfer per month
Installation Pricing:
• $249 - Limited Time Special >>
Click here for details!
<<
Seasonal Residential Premium
» Service for 6 continuous months
» $540 per year
» up to 3 Mb/s down & up to 1.5 Mb/s up
» 30GB of data transfer per month
Installation Pricing:
• $249 - Limited Time Special >>
Click here for details!
<<
Extreme Broadband - 2 year term
» $99.95 per month
» up to 5 Mb/s down & up to 3 Mb/s up
» 60GB of data transfer per month
Installation Pricing:
• $249 - Limited Time Special >>
Click here for details!
<<
Small Business - 2 year term
» $149.95 per month
» up to 10 Mb/s down & up to 5 Mb/s up
» 90GB of data transfer per month
Installation Pricing:
• $249 - Limited Time Special >>
Click here for details!
<<
Custom Service/Special
Please fill in details:
Caveats
First month's pro-rated service plus first full month's service due on completion of installation.
Start up cost due on completion of installation includes rental of radio modem and installation.
All prices are subject to HST, 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
Visa
MasterCard
Cancellation Policy
The antenna and equipment that we install belongs to Cottage Country Internet and it will need to be returned upon cancellation. Upon termination the customer shall, at its own expense, deliver the equipment to the Company at such place as the Company may designate in writing. The equipment shall be delivered to the Company in good order and repair except that ordinary wear shall be accepted.
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. If you have concerns about antenna placement please discuss this with the installer before he begins the installation.
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.
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