KyWIFi New Service Request

KyWiFi New Service Request

PLEASE DO NOT FILL OUT THIS FORM UNLESS YOUR SERVICE QUALIFICATION REQUEST HAS BEEN COMPLETED AND YOU WERE GIVEN APPROVAL FOR SERVICE WITHIN THE LAST 6 MONTHS. Complete this form in its entirety for accurate processing of your service request. Once this information is processed you will receive a phone call within 3 to 5 business days to set up an installation date and time.

Name*

First NameLast Name

E-mail Address*

Phone Number*

Service Address*

Mailing Address*

City*

Zip Code*

Own / Rent*

OwnRent / Lease

Is the house pre-wired?*

NoYes

Residential Service - Speed / Price / Agreement Length

Up to 10.0Mbps - 79.99 - 2 YearUp to 10.0Mbps - 89.99 - 1 YearUp to 15.0Mbps - 99.99 - 2 YearUp to 15.0Mbps - 109.99 - 1 Year

Non Profit Service - Speed / Price / Agreement Length

Up to 10.0Mbps - 89.99 - 2 yearUp to 10.0Mbps - 99.99 - 1 YearUp to 15.0Mbps - 109.99 - 2 YearUp to 15.0Mbps - 119.99 - 1 Year

Commercial Service - Speed / Price / Agreement Length

Up to 10.0Mbps - 99.99 - 2 yearUp to 10.0Mbps - 109.99 - 1 YearUp to 15.0Mbps - 119.99 - 2 YearUp to 15.0Mbps - 129.99 - 1 Year

EPP-Equipment Protection Plan - $4.99 Per Month(Optional)*

YesNo

Installation Payment Method*

Monthly Payment Method*

Debit CardCredit CardDirect Draft

Directions or Special Instructions - If you are a renter please provide the property owner's name and phone number.

Please be aware that the install is a basic install. The radio and antenna are placed in the locaton that allows for the strongest signal. The cable will be run on the exterior side of the structure and the cable will be penetrated either through an outside wall or up through the floor from a crawl space. Special requests are considered a custom install and will incur an additional charge.