Transcript
COMPLETE FORM, PRINT, SIGN, DATE and SEND APPLICATION TO: BEK Communications PO Box 230 Steele, ND 58482 PHONE: (701) 475-2361 or Toll Free at 1-888-475-2361 Fax: (701) 475-2321
Business High Speed Internet Application
Rev. 11/18/2010
CUSTOMER NAME
COMPANY NAME
ADDRESS HOME PHONE
CELL PHONE
CITY
ST
ZIP
WORK PHONE
Phone line that DSL will be on:
@bektel.com
CURRENT EMAIL ADDRESS WITH BEK CURRENT PASSWORD COMPUTER OPERATING SYSTEM: Windows 7
Windows Vista
Windows XP
Macintosh
Other
DO YOU HAVE AN AVAILABLE USB PORT (Circle One) Yes or No DO YOU HAVE A NETWORK INTERFACE CARD (NIC) INSTALLED? (Circle One) Yes or No DO YOU HAVE A FAX MACHINE (Circle One) Yes or No HOW MANY COMPUTERS WOULD YOU LIKE TO HAVE HOOKED UP TO HIGH SPEED INTERNET ______ HOW MANY PHONE JACKS DO YOU HAVE? ____________ DO YOU HAVE A SURGE PROTECTOR THAT HAS PHONE JACKS (Circle One) Yes or No WHAT SOFTWARE ARE YOU USING FOR VIRUS PROTECTION _____________________________________ INSIDE WIRING NEEDED? ($60 Per hour per employee) (Circle One) Yes or No Please Note: The quality of your inside wiring and the distance you are from our network equipment may affect the quality of service you receive.
NEW INTERNET CUSTOMERS ONLY: USERNAME SETUP Email will be
[email protected] USERNAME:
PASSWORD (must be a minimum of 8 characters Including at least one of each Capital Letter, lower case letter and number)
BEGIN SERVICE DATE
ADDITIONAL EMAIL ACCOUNTS For add’l emails please contact the office at 1-888-475-2361 I agree to abide by the most current Acceptable Use Policy and the Terms and Conditions Policy. The Terms and Conditions are subject to revision from time to time. The most current version will be posted on our website at www.bektel.com. I understand that surge and firewall protection are my responsibility. I also understand that if service is disconnected and then resumed at a later date, the set-up charge of $250.00 will be reassessed.
AUTHORIZATION
Signed_______________________________________
Date______________________
Continued on back
HIGH SPEED INTERNET ONE-TIME FEES INITIAL SETUP FEE $250.00 I want to commit to one continuous year of service and therefore have the $250 Setup Fee waived. (Account must be in good standing to qualify for waiver of $250 fee.) If disconnected for any reason during this 12 month commitment, the $250 fee will be assessed. An additional $250 fee will apply if I decide to reconnect. Please sign here ________________________________
RECURRING MONTHLY FEES Choose option 1 or 2 1. Business Bundle Plan—Free to Use Equipment Equipment remains property of BEK. Customer will be responsible for purchase of equipment if damaged (including damage as a result of inadequate surge protection). $91.95 price does not include mandated charges and taxes. Circle 6 calling features: 3-way calling, 3-way call transfer, 6-way calling, Add’l Directory Listing, Call Forwarding, Call Waiting, Distinctive Ringing, Do Not Disturb, Find Me, Last Call Return, Priority Ringing, Repeat Dialing, Selective Call Acceptance, Selective Call Forwarding, Selective Call Rejection, Series Completion, Speed Calling, Voice Mail 2. Up to 12MB downstream and up to 1MB upstream at $41.95 (includes 10 email) (Actual speed will be determined by the technology available in your area, inside wiring and customer owned equipment) A.
No Modem required
Fiber to the Home (NIC Card Required) OR
B.
Lease Modem $4.95/month Modem remains property of BEK. Customer will be responsible for purchase of modem if damaged (including damage as a result of inadequate surge protection.)
Additional Services Available 1. Do you want to sign up for SecureIT $4.95/month per computer (free activation with new High Speed Internet Applica tion valued at (19.95) (see enclosed brochure) YES OR NO 2. Static IP Addresses are available upon request at $10.00 each 3. 50MB additional Email storage at $3.00 per month
How did you hear about BEK High Speed Internet? CIRCLE ONE: Radio Newspaper Ad Bill Insert Friend BEK Beacon Brochure # ________ Other - please explain ___________
Email
Direct Mail
Employee
OFFICE USE ONLY Date Completed ____________________________________ Static
or Dynamic
(Check One)
Modem Serial Number _______________________________ Line Equipment _____________________________________
Static IP Address #1_________________________ Static IP Address #2_________________________ Subnet Mask_______________________________ Gateway__________________________________
Notes: _____________________________________________________________________________________________ _____________________________________________________________________INSTALLER__________________ M _________
Postini _________ MP __________ Addr ___________ Excel _________ Contract ________
