Fiber Internet Access Application Form

Fiber Internet Access Application Form

316 3rd Ave, P.O. Box 47, Clear Lake, WI 54005
Select City and Service *
Application Date*
Name*

First NameLast Name
Address*

Street Address

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Postal / Zip Code
Billing Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
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Cell Phone Number
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Email*
example@example.com
Additional Contact Name

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Additional Contact Phone Number
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Clear Lake Residential Fiber Internet Application
- There is a one-time connection fee of $199.95 to be paid prior to service installation.
- The ONT (Optical Network Terminal) and the indoor fiber going to the ONT is the property of NextgenBroadband and there are 120-volt AC power requirements for the ONT.
Fiber Only Rate Plans*

Fiber Link Bronze – 100 Mbps Download/20 Mbps Upload – $79.95/MonthFiber Link Silver – 250 Mbps Download/50 Mbps Upload – $99.95/MonthFiber Link Gold – 1 Gig Download/200 Mbps Upload – $199.95/Month
Equipment for Sale

Wireless Router $199.95 (Equipment purchased at our office is covered by Manufacturer warranty)8 Hour Battery Backup unit for telephone only over Fiber (requires power outlet to charge) $125.00
Additional Services

Preferred Customer Service (Ask Your CSR) $10.00/MonthSecure It Anti-Virus $4.95/mo.- $29.95 Set Up FeeAdditional Email Accounts $2.95/monthStatic IP Address $5.00/mo.-$85.00 Set Up Fee

Clear Lake Small Business Fiber Internet Application
- There is a one-time connection fee of $199.95 to be paid prior to service installation.
- All Small Business Rates include the Preferred Priority Service of $10.00 monthly.
- The ONT (Optical Network Terminal) and the indoor fiber going to the OBNT is the property of Nextgen Broadband. there will be 120-volt AC power requirements for the ONT.
Small Business Fiber Only Rate*

Fiber Link Bronze – 100 Mbps Download/40 Mbps Upload – $89.95/MonthFiber Link Silver – 250 Mbps Download/100 Mbps Upload – $109.95/MonthFiber Link Gold – 1 Gig Download/250 Mbps Upload– $209.95/Month
Equipment for Sale

Wireless Router - $199.95 Dual Band Gigabit Router with Wifi Management (Equipment purchased at our office is covered by Manufacturer warranty)
Additional Services

Secure It Anti Virus $4.95/mo. - $29.95 Set Up FeeStatic IP Address $5.00/mo. - $85.00 Set Up FeeAdditional Email Accounts $2.95/month

Glenwood City, Downing, Boyceville, & Townships of Cylon, Erin Prairie, and Emerald Residential Fiber Internet Application
- There is a one-time Special install fee of $50.00 to be paid prior to service installation. This special install pricing is for all new Fiber Internet small business customers, ask your CSR for more information.
- The ONT (Optical Network Terminal) and the indoor fiber going to the ONT is the property of Nextgen Broadband. There will be 120-volt AC power requirements for the ONT.
Residential Fiber Only Rate (Where Available)*

Fiber Link Bronze – 100 Mbps Download/20 Mbps Upload – $79.95/Month (Where Available)Fiber Link Silver – 250 Mbps Download/50 Mbps Upload – $99.95/Month (Where AvailableFiber Link Gold – 1 Gig Download/200Mbps Upload – $199.95/Month (Where Available
Additional Services

Preferred Priority Service (Ask Your CSR for details) $10.00/MonthSecure It Anti Virus Protection $4.95/mo. + $29.95 Set Up FeeStatic IP Address $5.00/mo. + $85.00 Set Up FeeAdditional Email Accounts $2.95/month
Acceptable Use Policy*

I agree and have read the Acceptable Use Policy

Glenwood City, Downing, Boyceville, & Townships of Cylon, Erin Prairie, and Emerald Small Business Fiber Internet Application
- There is a one-time Special install fee of $50.00 to be paid prior to service installation. This special install pricing is for all new Fiber Internet small business customers, ask your CSR for more information.
- The ONT (Optical Network Terminal) and the indoor fiber going to the ONT is the property of Nextgen Broadband. There will be 120-volt AC power requirements for the ONT.
- All Small Business Rates include the Preferred Priority Service of $10.00 monthly
Small Business Fiber Only Rate (Where Available)*

Fiber Link Bronze – 100 Mbps Download/40 Mbps Upload – $89.95/MonthFiber Link Silver – 250 Mbps Download/100 Mbps Upload – $109.95/MonthFiber Link Gold – 1 Gig Download/250 Mbps Upload – $209.95/Month (where available)
Additional Services

Secure It Anti Virus $4.95/mo. - $29.95 Set Up FeeStatic IP Address $5.00/mo. - $85.00 Set Up FeeAdditional Email Accounts $2.95/month
Acceptable Use Policy*

I agree and have read the Acceptable Use Policy

Spam filtering service and one email account are included in the High Speed Internet Service.

This High Speed Internet connection is for the exclusive use of the above named business or individual. It may be connected to serve multiple computers but they must all be owned by the business or individual listed above.This service may not be used to provide Internet connectivity to other entities or individuals. Access to this High Speed Internet connection via modem or other connection from off the customer’s premises is prohibited.
Customer Agreement

I, the undersigned, am requesting a Nextgen Broadband High Speed Internet access account (account). By signing this agreement I agree not to use the account for any purpose, which violates U.S., state or local laws. I agree not to use the account to interfere with or disrupt network users, services, or equipment. Such
interference or disruption includes, but is not limited to:
- distribution of unsolicited advertising;
- propagation of computer worms or viruses;
- use of the network to make unauthorized entry to other computational, information, or communications devices or resources.

I agree to hold Nextgen Broadband, its officers, agents and any of its members harmless from any liability arising from direct, special, indirect, or consequential damages including but not limited to any lost profits, loss
of opportunity, or any other loss which may result from the use of, misuse of, or lack of availability of Nextgen Broadband High Speed Internet access or Clear Lake Telephone Company facilities.

Certain Internet services may contain language or pictures which some individuals may find offensive, inflammatory, or of an adult nature. Such contents are the sole responsibility of the Internet service provider. Clear Lake Telephone Company as the Internet access provider has no control over the content of services available on the Internet. We do not endorse such materials and disclaim any and all liability for their contents.

In the event that you create a web page on the Internet, be aware that Nextgen Broadband reserves the right to disconnect service to pages, which are of an offensive, inflammatory, or of an adult nature.

Your account is not confidential by nature of the Internet. This means that you are responsible for protecting
your name, address, phone number and/or other personal information while on the Internet.

Customers signing this agreement are aware of all safety measures needed to protect any and all equipment that
will be plugged into the High Speed Internet Connection. Firewalls and switches are responsibilities of the customer to purchase and install to protect equipment plugged into the High Speed Internet Connection.
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Fiber Internet Access Application Form

Clear Lake Residential Fiber Internet Application

Clear Lake Small Business Fiber Internet Application

Glenwood City, Downing, Boyceville, & Townships of Cylon, Erin Prairie, and Emerald Residential Fiber Internet Application

Glenwood City, Downing, Boyceville, & Townships of Cylon, Erin Prairie, and Emerald Small Business Fiber Internet Application