1800 E. 17th St.
Idaho Falls, ID 83404
(208) 528-6161
200 S. Main Suite O
Pocatello, ID 83204
(208) 233-5802
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Internet Services Order Form
By filling out this form, you are committing to have internet services installed at the location listed for the prices listed.
You will be notified when the installation is scheduled. An adult will need to be at the location for the installation.
Your Full Name:
Address:
City:
State:
Zip Code:
Own or Rent:
Own
Rent
Day Time Contact Phone Number:
E-Mail:
Service Choice:
12 month - Residential 1meg - $39.95 per month, $99 setup
12 month - Residential 1.5meg - $49.95 per month, $99 setup
12 month - Residential 2meg - $59.95 per month, $99 setup
12 month - Residential 3meg - $99.95 per month, $99 setup
12 month - Residential 512k - $29.95 per month, $99 setup
24 month - Residential 1meg - $39.95 per month, $49 setup
24 month - Residential 1.5meg - $49.95 per month, $49 setup
24 month - Residential 2meg - $59.95 per month, $49 setup
24 month - Residential 3meg - $99.95 per month, $49 setup
24 month - Residential 512k - $29.95 per month, $49 setup
36 month - Residential 1meg - $39.95 per month, $0 setup
36 month - Residential 1.5meg - $49.95 per month, $0 setup
36 month - Residential 2meg - $59.95 per month, $0 setup
36 month - Residential 3meg - $99.95 per month, $0 setup
36 month - Residential 512k - $29.95 per month, $0 setup
12 month - Commercial 512k - $49.95 per month, $199 setup
12 month - Commercial 1meg - $99.95 per month, $199 setup
12 month - Commercial 1.5meg - $149.95 per month, $199 setup
12 month - Commercial 2meg - $199.95 per month, $199 setup
12 month - Commercial 2.5meg - $249.95 per month, $199 setup
24 month - Commercial 512k - $49.95 per month, $149 setup
24 month - Commercial 1meg - $79.95 per month, $149 setup
24 month - Commercial 1.5meg - $119.95 per month, $149 setup
24 month - Commercial 2meg - $149.95 per month, $149 setup
24 month - Commercial 2.5meg - $199.95 per month, $149 setup
36 month - Commercial 512k - $49.95 per month, $99 setup
36 month - Commercial 1meg - $49.95 per month, $99 setup
36 month - Commercial 1.5meg - $79.95 per month, $99 setup
36 month - Commercial 2meg - $99.95 per month, $99 setup
36 month - Commercial 2.5meg - $149.95 per month, $99 setup
None
Add VoIP phone service?
No
Yes for only $24.95 per month extra!
How did you hear about Microserv?
Salesperson
Newspaper
Radio
Door Hanger
Friend / Neighbor
Postcard
Microserv Employee
Other
Name:
Current service:
None
Cable
DSL
Dial-up
Other wireless
New location
I agree that this is a 12-36 month contract, and that Microserv retains ownership of all equipment even after the contract period. I understand and agree that early cancellation will result in 100% of the remaining contract amount due and payable immediately.
I also hereby certify that I have authority or permission to have an antenna mounted on the outside of the property listed above.
By clicking below, I agree to all the terms and conditions listed above.
Copyright 2009 Microserv Computer Technologies. All Rights Reserved.
Your IP Address is:
38.107.191.94
