Transcript
Fax Order Form To 908-464-8967
Comcast High-Speed Internet CUSTOMER INFORMATION
DATE & TIME OF ORDER
Cottage Computers Customer FIRST Name
Customer LAST Name
Cable TV Account #
Street Address / Floor or Apt / Condo #
City / Town
Zip Code
Home Telephone #
Work Telephone #
Best Day / Time to Call
Name on Cable Account (if different)
Current Email Address
COMPUTER QUALIFICATIONS Processor:
10 Cottage Street Berkeley Heights, NJ 07922 908-464-8386
[email protected] www.CottageComputers.com
(A) PC / IBM Compatible 300 MHz or higher
(B) Apple / Mac PowerPC 603 / 200 MHz for 9.x Power MAC G3 for 10.x
RAM: 64MB (128MB for XP) 64MB for 9.0x, 128MB for 10.x Free Disk Space: 150MB 100MB Operating System (circle) Windows: 98x 2000 ME XP Version 9.0 thru 10.2 excluding 10.0 Peripherals CD-ROM, USB Port recommended CD-ROM, USB Port optional Desktop _____ OR Laptop _____(Laptop users must have their own pre-installed PCMCIA Network Interface Card)
Please inform customer to “back up” system prior to attempting installation of any new software and/or hardware.
A
1. INSTALLATION OPTIONS Check One a. PRO Install ($49 for cable subs, $99 for non-cable subs) $ b. Self-Installation* $ 0.00 Self-Install kit picked up at retail location Ship self-Install kit to customer (s & h charge) $ 9.95 2. MONTHLY SERVICE COSTS a. Comcast Cable TV Subscriber b. Non-Comcast Cable TV Subscriber
B
Modem Manufacturer / Model Number Customer Serial Number
Check One
$ 42.95 $ 57.95
3. MODEM OPTIONS a. Modem Rental (per month rate) b. Modem purchase from Comcast …if a or b choose one:
Retail / Customer Owned Modem
Mac Address / #
Check One
$ 3.00 $139.00
Ship to Address for Self-Install Kit / Cable Modem
Network Interface Card OR USB adapter (only for computers running Windows 98, ME or XP)
Must match service address
c. Modem purchase from Retailer – gather info in Box B d. Customer already owns modem – gather info in Box B 4. PROMOTIONAL OFFER a. Six months at $19.99 per month
Check One
$ 19.99
C
PRO Installation Only
Promotional offer is available to current cable customers ONLY! *All costs do not include equipment fees, franchise fees or applicable taxes.
*Offer Expires Soon!
Requested Installation Day (M-Sat)
AM / PM
. IDENTIFICATION Name on Credit Card
Credit Card #
Expiration Date
Visa, MC, AMEX, Debit, Credit
Driver’s License #
Expiration Date
Customer Signature
Date
Prices indicated are for Standard or Self installation for residential customers for a single computer and may not include all applicable fees and taxes. Billing will be on a Comcast statement. If not a Cable TV customer, or getting Cable TV and Comcast High-Speed Internet, COD equal to installation charge and 1st month service charge is due at the time of professional installation only.
