BROADBAND MEMBERSHIP APPLICATION |
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| The fields marked with a *
are required. We require a valid method of contacting all
customers so that we may confirm an order. If you do not fill
all of the required fields, we will be unable to create the
account. |
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| First Name: |
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| Last Name: |
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| Mailing/Billing Address: |
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| City: |
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| State: |
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| Zip: |
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| Phone Number: |
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| If you are signing up on behalf of a non-profit or charitable organization, please enter the full name of the qualified organization here: |
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| TYPE OF ACCOUNT DESIRED * |
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| Standard Residential |
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Standard Wireless - 1 month contract $49.95 per month,
Basic Residential Wireless Service ($199.00 Install) |
1 Year Contract - $49.95 per month,
Basic Residential Wireless Service ($99.00 Install) |
2 Year Contract - $49.95 per month,
Basic Residential Wireless Service (Free Installation) |
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| Basic Business |
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1 Month Contract - $129.00 per month,
Basic Business Wireless Service ($199.00 Install) |
1 Year Contract - $129.00 per month,
Basic Wireless Service ($99.00 Install) |
2 Year Contract - $129.00 per month,
Basic Business Wireless Service (Free Install) |
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| PRO-RATING OF PRESENT MONTH |
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| On all new accounts it is our policy to pro-rate the first month. |
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| METHOD OF PAYMENT |
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| Enter the name shown on your credit card:
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| Credit Card Type: |
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| Credit Card Number:
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*
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| Expiration Month/Year: |
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| CVV/CVC/CID Number: |
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| QUESTIONS AND COMMENTS |
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| By submitting this form, you
are authorizing ARINC-Cybertime Network Services to charge
your credit card. |
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| Furthermore, you affirm that
you have read and agreed to all CNS terms of service (TOS),
Acceptable Use Policies (AUC), and conditions. |
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| Click
here to view TOS, AUP, and conditions. |
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