Residential ILEC

Full Name
Secondary Contact Full Name
Best Contact Method

EmailPhone
Cell Phone Number
Email
Street Address
City
Street
Zip Code
Do you rent or own the property?

RentOwn
Landlord Name
Landlord Phone Number
Internet
Internet Options

Up to 50/50Mbps High Speed Internet - $40.00Up to 100/100Mbps High Speed Internet - $50.00Up to 250/250Mbps High Speed Internet - $60.00Up to 500/500Mbps High Speed Internet - $100.00Up to 1 Gigabit High Speed Internet - $200
Would you like to lease a Gigacenter router?

YesNo
WIFI Username
Preferred Passcode
Must be at least 8 characters.
Do you want to add a static IP?

NoYes ($32 one-time installation fee) - $5.95
Arlo Security Cameras

Arlo Pro 4 CameraArlo Video Doorbell
How many?
The first Arlo device is $15/mo. Each additional device is $10.00/mo.

Installation – $25 per camera (one-time fee)

Maintenance Fee – $3/mo.
Telephone
Telephone Options

Residential Phone - $22.50Unlisted/Non-Publish - $0.00Caller ID Name and/or # - $4.50Telemarketing Screening - $1.00Premium Voicemail - $5.95Call Forwarding - $1.503-way Calling - $.50Call Waiting - $.50
Would you like Long Distance Telephone Service?

Yes, I would like Comm1's Flat Rate of $.05 per minuteYes, I would like to use a different long distance providerNo, I only need local calling
Additional Long Distance Service Options

Comm1 offers several choices of long distance carriers. Customers are not required to use Comm1’s long distance. If you would like to use a different carrier, please list your choice in the Interlata and Intralata areas below. If using a carrier other than Comm1, you must contact them to set up account.
Interlata
Intralata
Will you be porting a phone number?

Yes - $1.50/mo.No
Needed information for phone number porting
Current Phone Number
Current Service Provider
Account Number
PIN Number
Cable TV
Cable TV Options

Expanded Digital Cable - $122.00Basic Cable - $77.00DVR - $11.00
Digital Boxes

1 - $0 (included at no additional charge)2 - $5.003 - $10.004 - $15.005 - $20.00
Each TV needing Cable service requires a Digital box. The first box is included with your service at no additional charge. Each additional box is $5.00 per month. Customer is responsible for returning all equipment upon discontinuation of service. If not returned, a $200 charge will be incurred per box.
Would you like Premium (movie) Channels? - Individual

YesNo
How many Premium Channels would you like? - Individual

One premium channel - $18.00Two premium channels - $33.00Three premium channels - $48.00Four premium channels - $62.00
Choose your Premium Channels - Individual

CinemaxHBOShowtimeStarz/Encore
ALL PRICES SHOWN DO NOT INCLUDE REGULATORY FEES AND TAXES. INSTALLATION AND EQUIPMENT CHARGES MAY APPLY. ALL SERVICES SHOWN MAY NOT BE AVAILABLE IN ALL AREAS. SPEEDS LISTED INDICATE POTENTIAL DOWNLOAD SPEED OF SERVICE. UPLOAD SPEEDS WILL BE LESS THAN DOWNLOAD SPEEDS AND VARY BASED ON PRODUCT DELIVERY. CONTACT OFFICE FOR FULL DETAILS.
Additional Contact Information
Mailing Address
City
State
Zip Code
Personal Information
Occupation
Last four digits of SSN#
Employer
Date of Birth
Daytime Phone Number
Secondary Phone Number
I authorize the Communications1 Network Company to conduct a credit inquiry according to the previous statements and answers on this application form:

YesNo
Acknowledge your consent to a credit inquiry according to the previous statements and answers on this application.
Today's Date
Security question - What is your mother's maiden name?
CPNI Opt Out

YesNo
Email Information
Would you like your bill emailed to you?

YesNo
Comm1 e-mail address - $1.00 per month per email address

YesNo
Please provide the following information for your Comm1 Email Account
Preferred Username
Preferred Passcode
Auto Pay

With our Auto Pay program, you will not have to write another check to pay for your monthly communications bill. When you enroll, we will automatically deduct the “Total Amount Due” (found on your bill) from your checking account on the 5th of each month. You will continue to receive your monthly bill for review, but it will reflect ‘Direct Payment Program’ authorization, unless you choose e-bill only option.
Auto Pay Options

I wish to use Electronic Banking
Which type of account?

CheckingSavings
Name of Bank/Credit Union
Routing Number
Account Number
Signature
STATEMENT OF NONDISCRIMINATION – Communications 1 Network, Inc. is the recipient of Federal financial assistance from the U.S. Department of Agriculture (USDA). The USDA prohibits discrimination in all the programs and activities on the basis of race, color, national origin, age, disability and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication or program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination, write to USDA Director, Office of Civil Rights, 1400 Independence Avenue S.W., Washington, DC 20250-9410, or call toll free (866) 632-9992 (voice) or 800-877-6339 (TDD) or (866) 377-8642 (relay voice users). USDA is an equal opportunity provider and employer.
Wire Maintenance

I would like to subscribe to the Wire Maintenance Plan for $3.00 per month. With the wire maintenance plan, Comm1 will repair or replace any inside wiring that creates a service problem.
Please add wire maintenance to my account

YesNo
Customer Compliance Agreement and Authorization

By establishing an account with Comm1 or using any software provided, developed, licensed or owned by Comm1. I AGREE TO BE BOUND BY THIS AGREEMENT AND TO USE THE services in compliance with this agreement and other Comm1’s policies posted from time to time on comm1net.net.I understand that all charges listed on this application are monthly (with the exception of installation) and do not include taxes and regulatory fees.I authorize Comm1 to install all appropriate equipment for the services I have requested. I understand that all policies and procedures can be found on Comm1’s website or given upon request. All adults are required to sign this application.
Acknowledge this agreement and authorization
Today's Date
Should be Empty:

Internet

Telephone

Additional Long Distance Service Options

Needed information for phone number porting

Cable TV

Additional Contact Information

Personal Information

Email Information

Please provide the following information for your Comm1 Email Account

Auto Pay

Wire Maintenance

Customer Compliance Agreement and Authorization