Internet, Telephone, dynamicTV
Application for Service
Customer Information
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Billing Name (if different)
First Name
Last Name
Billing Address (if different)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
example@example.com
Are you under contract with your current provider?
Yes
No
If yes, what is the your contract expiration date?
How did you hear about us?
Do you rent or own?
Rent
Own
If renting, name & number of landlord.
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Internet
Includes a router and in-home WiFi with NO monthly fees and 10 email addresses. Additional speeds are available.
Residential Internet
100Mb: $54.95/mo
250Mb: $67.95/mo
500Mb: $109.95/mo
Business Internet
200Mb: $94.95/mo
400Mb: $147.45/mo
Primary Email Address requested
______@ncn.net. Must be 8 characters or less
Telephone
No contract term. Includes one line & 100 long distance minutes. Can keep current number.
Telephone Options
Residential: $24.79/mo
Business: $35.74/mo
Non-Published/Non-Listed Listing: $3.00
500 Minutes of Toll: $5.00/mo
dynamicTV
No Contract term. Provided by Northern Iowa Communications Partners, NICP
dynamicTV Options
Broadcast Basic: $63.08 (includes 1 whole home DVR)
Broadcast Basic Plus: $119.45 (includes 1 whole home DVR)
Broadcast Premium: $138.51/mo (includes 1 whole home DVD & 1 regular receiver)
Additional Set Up Box: $5.35/mo
Installation of Additional Receiver: $42.80
Premium Channels
Cinemax: $15.52/mo
Showtime: $16.05/mo
Starz/Encore: $9.63/mo
HBO: $18.73/mo
When moving to a new building, a $75 installation will apply. If moving dynamicTV boxes, a $40 fee will apply
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Customer Service Agreement
I understand and acknowledge that continued use or Pocahontas Fiber Network’s Service constitutes acceptance of the Terms of Service. Acceptable Use Policy and other important policies posted on Pocahontas Fiber Network’s website www.pocahontasfibernetwork.com. I agree it is my responsibility to read these policies and comply fully with their terms. I farther understand the policies and pricing of Pocahontas Fiber Network’s services may change from time to time upon 30 days notice. The service is provided on an ‘AS IS’ and ‘ AS AVAILABLE’ BASIS WITHOUT WARRANTIES OF ANY KIND, EITHER EXPRESSOR IMPLIED, INCLUDING BUT NOT LIMITED TO WARRANTIES OF TITLE OR IMPLIED WARRANTIES OF MECHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. If service is canceled and equipment is not returned in working order within 10 business days, customer agrees to pay an equipment charge. To request a copy of our Terms of Service, Acceptable Use Policy, Equipment Changes and other policies, call our Customer Care Department at800-249-5251 or visit our website at www.pocahontasfibernetwork.com.
I agree to these terms (initial here)
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Standard Installation Terms
Standard installation includes installation of Internet equipment and connection to one computer and in-home WiFi. Installations that require extraordinary time or resources will be billed an additional charge. Customer will be informed of charges prior to installation. Monthly service charge includes use of all Pocahontas Fiber Network’s dynamicTV equipment. Ownership is retained by Pocahontas Fiber Network. If service is canceled and equipment is not returned in working order within 10 business days, customer agrees to pay an equipment charge.Inside wire maintenance free for first 6 months.
I agree to these terms (initial here)
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Customer Signature
Note: Signing this order form and agreement indicates I accept and understand the Customer Service Agreement and the Standard Installation Terms.
Signature
Submit
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