Bevcomm Service Application

1
Full Name* This field is required.
First Name
Last Name
2
Mobile Phone Number* This field is required.
3
E-mail* This field is required.
example@example.com
4
Service Address* This field is required.
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
5
Billing Address* This field is required.
Same as service address
Different address
6
Billing Address* This field is required.
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
7
Would you like to add a secondary authorized user to your account? * This field is required.
YESNO
8
Secondary Authorized User * This field is required.
First Name
Last Name
9
Secondary Authorized User Phone Number* This field is required.
Please enter a valid phone number.
10
Would you like to enroll in auto-pay?* This field is required.
YESNO
11
Automatic Bank Payment* This field is required.
Please Select
Please Select
Checking
Savings
Account type
Name of Bank
Routing Number
Account Number
12
Would you like to enroll in paperless billing?* This field is required. If so, I understand I can print my invoice from my ebilling account.
YESNO
13
What email would you like your invoice notification sent to?* This field is required.
example@example.com
14
What services are you looking for?* This field is required.Please select the response that best suits your needs.
High-Speed Internet
Digital TV
Home Phone
Multiple Services
I am an existing customer and would like to make changes to my current services.
15
Select your Bundle Package* This field is required.TV packages include 150+ channels, 100x100 Mbps* Internet with unlimited, popular calling features, and 100 minutes of long distance. *All fees detailed are billed monthly, rates do not include mandated taxes and fees. Internet speeds are subject to availability.
$202.95 - Digital Access 4: TV + MOVIE CHANNELS + INTERNET + PHONE
$171.95 - DIGITAL ACCESS THREE: TV + INTERNET + PHONE
$160.95 - DIGITAL ACCESS TWO: TV + INTERNET
$131.95 - DIGITAL ACCESS ONE: TV + PHONE
16
Select your High-Speed Internet Package with Unlimited Data* This field is required.Use our bandwidth calculator to help determine the speed that best suits your needs. Bandwidth Estimator – Bevcomm StreamNow (gostreamnow.com) Get $10 off when you combine internet and phone services. *All fees detailed are billed monthly, rates do not include mandated taxes and fees. Internet speeds are subject to availability, if these speeds are unavailable in your location a customer service representative will reach out to you.
$89.95 - FASTEST: GIG x GIG
$74.95 - FASTER: 500 x 500 Mbps
$59.95 - FAST: 100 x 100 Mbps
17
Are you interested in connecting wirelessly?* This field is required.Strong Wi-Fi, secure connection, plus manage your devices through a portal for an additional $7.95 per month.
YESNO, I HAVE MY OWN ROUTER.
18
Select your Bevcomm TV Package* This field is required.View our lineup and packages here.Channel Guides (bevcomm.net)
$65.95 - Basic TV
$123.95 - Expanded Basic
19
You selected a Basic TV plan. What features would you like to add? Channel Guides (bevcomm.net)
$12.95 - High-Definition TV (HDTV)
$10.95 - DVR (500 GB)
20
You selected an Expanded Basic TV plan. What features would you like to add? Channel Guides (bevcomm.net)
$12.95 - EASE
$12.95 - High-Definition TV (HDTV)
$10.95 - DVR
21
Would you like to add movie channels/premium subscriptions?
$16.95 - HBO
$13.95 - Cinemax
$14.95 - Showtime
$14.95 - Starz/Encore
$24.95 - HBO/Starz/Encore
$46.95 - All movie channels
$14.95 - Playboy
$59.95 - Redzone (per season annual fee)
22
On how many TVs do you want to watch Bevcomm TV?* This field is required.Each TV requires a set-top box at a rate of $4.95 per month.
23
Our Home Phone service is $31.18 per month, are you interested in adding a Long-Distance Plan?* This field is required.$31.18 per month
YESNO
24
Please select the Long-Distance Plan that fits your needs.* This field is required.
$1.95 per month, 12.9 cents per minute
$6.95 - 100 minutes
$23.95 - 500 minutes
$44.95 - 1000 minutes
25
What changes would you like to make?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
26
Are you interested in a bevcomm.net email address?* This field is required.$1.95 per month.
YESNO
27
What would you like your username to be?* This field is required.
example@bevcomm.net
28
Do you want free installation (valued at $99)? Subscribe to WirePro.* This field is required.$5.00 per month WirePro is designed to protect you from costly maintenance charges when customers experience trouble with telephone, broadband, or TV services. Essentially, it is an “insurance policy” against one-time repair bills, much like the insurance you carry on your car or home. When the customer subscribes to WirePro they will not be billed trip charges for troubles found within the home. With WirePro you avoid costly service charges that normally apply when we dispatch a technician and find the trouble inside the home. WirePro will cover inside wiring, regardless of service, as long as wiring is up to industry standards.
YESNO
29
Do you qualify for low-income discounts or want to learn more?* This field is required.Bevcomm participates in the FCC's Affordable Broadband Plan and Lifeline. If you are interested in learning more about low-income discounts, please let us know. A customer service representative will contact you with more details or learn more by clicking the link below. Affordable Connectivity Program (ACP) or Lifeline (bevcomm.net)
YESNO
30
Do you have any additional comments, questions, or concerns that have not been addressed already?
Huge
Large
Normal
Small
Ok
Ok
31
You've made it to the end!* This field is required.Please review our acceptable use policy and confirm that you have read it. By ordering and accepting Service, you agree to adhere to our Terms and Conditions and/or Internet Acceptable Use Policy, including any modifications as we may communicate to you from time to time. You can find the Terms and Conditions on our website. We will also send you a copy of our Terms and Conditions if you send your written request to our business address as shown on your monthly bill. Prices in this application do not include taxes or USF charges. Here is a link to all of our notices and policies. News (bevcomm.net)
Yes, I've read it.
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