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New Service Form
New Service Form
Customer Service Address Information
(Address in Colorado)
First Name:
*
Last Name:
*
Email address
*
Phone:
*
Colorado Service Address:
*
Colorado City:
*
Colorado Zip Code:
*
Service Information
(For pricing click on either Seasonal or Resident)
Speeds:
*
Option 1 - 10M, $60/month
Option 2 - 25M, $80/month
Install Cost
*
$99 install - 30 Month Contract
$299 install, Month to Month - ($10/month vacation hold when not in service, and can suspend for up to 6 months a year, but needs to be 6 months of continuous service within the calendar year). 30 Month contract.
Wireless Router
*
I would like for HuerfanoTel to supply one - $60
I will supply my own router and will program the router myself or have a third party program the router for me. I understand that HuerfanoTel will not supply tech support for my router.
Type of Install
*
No one is at the location, but you can install service. (In the notes section let us know how we will access inside the location, such as a neighbor or lock box, etc.).
Someone will be at the location.
Time frame for Installation
*
I need the Internet as soon as you can install it.
I'd like the Internet installed at a later date. (If you know a time frame, please enter estimated date below)
What is you estimated date or time frame for installation? *
+
Installation type
*
Someone will be at the location on day of install.
You can call someone to let you in.
No one is at the location, but there is a lock box.
No one is at the location, but there is a hidden key.
Name
*
Number
*
Lock box number
*
Hidden Key Location
*
Check to confirm the information below
I have the Terms of Service and Privacy Statement below and agree to the terms out line therein.
*
Terms of Service and Privacy Statement
Check to confirm the information below
I understand that submitting this signup form does not guarantee that HuerfanoTel can provide service to my location. And, if HuerfanoTel cannot provide service I am not liable for any service charges or fees.
*
Notes or special requests?