Clone of Corbett Home Service Application

Thank you for your interest in Reliance Connects. Please take a few minutes to complete this application to get started. A customer service representative will contact you by the next business day to confirm details and schedule installation. Some homes may require additional work before fiber service can start.

Before you begin, please know that parts of this application will request sensitive information. All sensitive fields are fully encrypted, and the information is used only for identity verification and account setup. You can learn more in our Privacy Policy and Terms & Conditions.

Service Address*

Street Address

Street Address Line 2

CityState

Zip Code
Is this home new construction?*

No, This home is not new constructionYes, We will be the first people to live in this home
Please Note:

New construction homes often need outside fiber work before installation. Connecting the home to the street can take additional time, even if the inside of the home is already wired.
Is this address for an RV, trailer, or other movable dwelling?

No, My home is a permanent structure.Yes, My home is an RV, trailer, tiny home, or another movable dwelling.
Please Note:

A 6 Month contract term or $125 installation fee is required for all new Internet service in RVs or movable dwellings.
Do you own this home or are you renting?*

I own this homeI am renting this home
We request the property owner’s information to verify installation approval and ensure all required permissions are in place.
Property Owner/Landlord name *

First NameLast Name
Property Owner/Landlord Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.

Tell Us About Yourself

This section includes personal information that helps us verify your identity and set up your account. Some of these fields are considered sensitive and are fully encrypted for your protection. Each question includes a note explaining why we need it.
Main Applicant Name *

First NameLast Name
Main Applicant Birth Date*

MonthDayYear
Main Applicant Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Main Applicant Email
example@example.com
Drivers License Number (Optional to Enter Online)
Your information is fully encrypted in this secure form and used only for identity verification. It is never shared or used for any other purpose. If you prefer, you may skip this field and provide it to a CSR during your setup call. Entering it now helps ensure a smooth and efficient setup process.
Social Security Number (Optional to Enter Online)
Your information is fully encrypted in this secure form and used only for the soft credit check required to determine your deposit options. This check does not affect your credit score, and we do not see your full credit report, only a simple 1-to-3 star rating. Your information is never shared or used for any other purpose. If you prefer, you may skip this field and provide it to a CSR during your setup call. Entering it now helps ensure a smooth and efficient setup process.

Employment Information

Providing employment information is optional, but it can be helpful if you’re concerned your credit rating may be on the lower side. If you have at least one year of steady full-time employment, we may be able to use this in place of a credit score and waive the standard $150 account deposit.
Main Applicant Current Employer
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Position
Years Employed With This Company
Supervisor

Co-Applicant

A co-applicant is a person who will jointly share financial responsibility for your Reliance Connects account. This is usually a spouse or household member who also needs full account access. This is different from an authorized user, who can help manage the account but is not responsible for the bill. You’ll be able to add authorized users in a later section.
Would you like to add a Co-Applicant to your account?*

Yes, I would like to add a Co-ApplicantNo, I will be the only one financially responsible for the account
Co-Applicant Information

This section includes personal information that helps us verify your identity and set up your account. Some of these fields are considered sensitive and are fully encrypted for your protection. Each question includes a note explaining why we need it.
Co-Applicant Name *

First NameLast Name
Co-Applicant Birth Date*

MonthDayYear
Drivers License Number (Optional to Enter Online)
Your information is fully encrypted in this secure form and used only for identity verification. It is never shared or used for any other purpose. If you prefer, you may skip this field and provide it to a CSR during your setup call. Entering it now helps ensure a smooth and efficient setup process.
Social Security Number (Optional to Enter Online)
Your information is fully encrypted in this secure form and used only for the soft credit check required to determine your deposit options. This check does not affect your credit score, and we do not see your full credit report, only a simple 1-to-3 star rating. Your information is never shared or used for any other purpose. If you prefer, you may skip this field and provide it to a CSR during your setup call. Entering it now helps ensure a smooth and efficient setup process.

Employment Information

Providing employment information is optional, but it can be helpful if you’re concerned your credit rating may be on the lower side. If you have at least one year of steady full-time employment, we may be able to use this in place of a credit score and waive the standard $150 account deposit.
Co-Applicant Current Employer
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Position
Years Employed With This Company
Supervisor

Authorized Users

Authorized users are people you trust to access your account. They are not financially responsible and do not share ownership of the account. Authorized users are often adult children, other family members, or anyone you want to have access to important account information. Authorized users will be asked to verify their identity using their birthday before any account information can be shared.
Would you like to add an Authorized User to your account?*

Yes, I would like to add authorized users to my accountNo, I would not like to add any authorized users to my account
Authorized User 1*

First NameLast Name
Authorized User 1 Birth Date

MonthDayYear
Permission Level for Authorized User 1*

Information Only – They can ask general questions about your account, such as checking service status or inquiring about outages.Account Changes – They can make updates to the account, including modifying service packages or adjusting account features on your behalf.
Would you like to add a second authorized user to your account?*

Yes, I would like 2 authorized users on my accountNo, I only want 1 authorized user
Authorized User 2*

First NameLast Name
Authorized User 2 Birth Date

MonthDayYear
Permission Level for Authorized User 2*

Information Only – They can ask general questions about your account, such as checking service status or inquiring about outages.Account Changes – They can make updates to the account, including modifying service packages or adjusting account features on your behalf.

Phone Service

You may add home phone service to your account. Phone service can be paired with most internet packages for discounted rates.
Would you like phone service in addition to your internet service?*

Yes, I would like to add phone serviceNo, I do not want phone service
**VERY IMPORTANT** By selecting phone service, you acknowledge that your phone line will be delivered over fiber. Fiber phone service requires power, which means you will need a battery backup or generator to keep your phone working during a power outage, including for 911 calls.*

I understand that my phone will not work without power, this includes 911 calls

Elkton Phone Service Options

Below are the phone service options available in the Elkton area. Everyone begins with Basic Telephone Service, and you can choose an Extended Area Service (EAS) package if you regularly call the nearby communities listed.
Basic Telephone Service — $32.00/month
With Basic Telephone Service, you receive unlimited incoming calls, and all outgoing calls to any 541 area code number are billed at $0.05 per minute.
This is your standard monthly phone rate and does not include any EAS calling areas.

If you frequently call neighboring communities outside of the basic local area, you may want to add one of the Unlimited EAS packages below for predictable monthly pricing.
EAS Packages*
Choose Your Long Distance Plan - *

Call Manager - Included With Your Phone Line

Call Manager is our built-in call-screening and spam-blocking feature, available to all phone customers at no extra cost. It helps reduce unwanted robocalls, blocks known spam numbers, and screens unknown callers before they ring through. You can also approve numbers you want to receive and manage your settings at any time. Call Manager can be managed through your online portal or by calling our office. ***if you currently receive automated phone calls from a bank or any other institution these will be blocked, and you will need to provide the number to us for this call to be allowed
Would you like Call Manager activated on your line?*

Yes, activate Call ManagerNo, I do not want Call Manager

Phone line Add-ons
Would you like to add any of the following options to your phone line?*

No Add-on ServicesCaller ID - (Name and Number) - $5.00/mo.Caller ID - (Number Only) - $3.95/moCall Waiting (Standard) - $1.75/mo.Call Forwarding - $1.75/mo.Teen Line - $3.95/moVoice Mail - $5.95/moUnpublished Number - $0.50/mo
Additional phone options may be available. If you have any questions please ask our customer service rep when they reach out to complete your account setup.

Choose Your Internet Plan

Choose the internet speed that fits your home best. Every plan includes unlimited data and all necessary equipment, so you can enjoy reliable fiber for streaming, working from home, gaming, and keeping your whole household connected.
Choose Your Internet Plan*
Fiber 100 - Great for everyday browsing, email, and light streaming on a few devices.

Fiber 250 - Perfect for HD streaming, online learning, and smooth video calls from home.

Fiber 500 - Ideal for families with multiple devices, frequent video conferencing, and fast downloads.

Fiber GIG - Best for heavy streaming, gaming, smart homes, and ultra-fast performance on every device.

Choose Your Internet Plan

Because you chose phone service, the internet plans below reflect your discounted pricing. Each plan includes unlimited data and all necessary equipment. The internet price shown will be added to your selected phone package.
Choose Your Internet Plan*

Customer Provided Equipment (Optional)

You may use your own router if you prefer. Please note that when customers use their own equipment, our Help Desk cannot provide technical support or troubleshooting for the router, since every model works differently and settings vary by manufacturer. We strongly recommend using the equipment included with your service, which comes with our Managed Wi-Fi for the best performance and full support. If you choose to use your own router, an $8.00 monthly discount will be applied to your bill.
Will you be providing your own equipment?*

No - I will use the included router and Managed Wi-Fi (recommended for best performance and full support).Yes - I will use my own router and understand that router support/troubleshooting is not provided and my bill will include an $8/mo discount.

Static IP

A Static IP is a fixed, unchanging internet address used for advanced setups like remote camera access, VPNs, or servers. Most homes do not need a Static IP unless specifically required for your setup.
Would you like to add a Static IP address to your account?*

Yes, I need a Static IP for a specific setup and would like to add it for $5.00/mo.No, I do not need a Static IP (applicable for most customers).

Inside Wire Maintenance

Your home’s internal wiring can wear down over time, which may cause issues with your internet or phone service. Inside Wire Maintenance protects you from unexpected repair costs by covering the replacement or repair of naturally degraded wiring inside your home. This service is just $1.35 per month and can save you from expensive service calls if your wiring ever fails. (Damage from rodents, accidents, or intentional harm is not covered.)
Would you like to add Inside Wire Maintenance to your account?*

Yes, please add Inside Wire Maintenance to my account for $1.35/moNo, I do not need inside wire maintenance at this time

How did you hear about us?

Friend / Family referralOnline searchSocial mediaCommunity event or sponsorshipOther
We believe in rewarding our existing customers for sharing the love. If a friend or family member referred you to us, please let us know who they are! As a thank you, we’ll give them a $25 bill credit, and you’ll receive $10 off your first bill.
Referring customer name

Reliance Connects equipment (specifically the router) must be returned upon disconnect, or I will be charged for the retail market value*
Initial here
Wireless service is not guaranteed. We recommend our premium WIFI router with managed WIFI for connecting wireless devices.*
Initial here
I understand a required one-time connection fee of $27 applies to all new accounts.*
Initial here
I hereby request service from Cascade Utilities LLC dba RELIANCE CONNECTS, and I agree to abide by all provisions of its terms and conditions, including but not limited to deposit requirements, payment obligations, and our acceptable use policy. Further, I agree to pay attorney fees, court costs, and collection costs if the Company is required to take any action to collect any amounts due for the provision of service or to enforce any terms of its terms and conditions. View the terms and conditions at http://relianceconnects.com/legal/*
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Tell Us About Yourself

Employment Information

Co-Applicant

Co-Applicant Information

Employment Information

Authorized Users

Phone Service

Elkton Phone Service Options

Call Manager - Included With Your Phone Line

Phone line Add-ons

Choose Your Internet Plan

Choose Your Internet Plan

Customer Provided Equipment (Optional)

Static IP

Inside Wire Maintenance