Broadband Internet Service Agreement Template printable pdf download

Broadband Internet Service Agreement Template

LMi.net PHLO

Broadband Internet

1/18/12

Page 1 of 4

CUSTOMER INFORMATION

Company Name: _____________________________________________________________________

Contact Name: _______________________________________________________________________

Billing Address: _________________________________________________ Suite/Unit: __________

City: ____________________________________________ State: __________ Zip: _______________

Phone: __________________ Contact E-mail Address (required): ________________________________

VISA

AMEX

Card Number: ___________________________________ Exp: _______

Signature of Card Holder: __________________________________________________

PHLO INSTALLATION LOCATION

Address: ______________________________________________________ Suite/Unit: _____________

City: ____________________________ State: ________ Zip: _______________

(Optional) Installation Telephone Number: _________________________________________________

MPOE (Minimum Point of Entry) Outside Accessible: yes: _____no: _____

NOTE: PHLO not available in all areas.

NOTE: Inside wiring from MPOE to installation area is necessary.

NOTE: A working Ethernet card or port is required in your computer to run PHLO services.

NOTE: You need a phone outlet in the room where you want PHLO deployed (active phone service is not required).

LMi.net OFFICE USE ONLY

ORDER #: ___________ IP(s) ASSIGNED: _________________________

PHLO DUE DATE: ________________________ PHLO START DATE: _______________________________

EMAIL ADRESSES SET UP: ___ DATE: ___________ WHO: _______________________________

ROUTER/MODEM TYPE: ________________________________________

AT&T MPOE DATE/TIME: ____________________________ CUSTOMER NOTIFIED: __________

PHLO INSTALL DATE/TIME: __________________________ CUSTOMER NOTIFIED: __________

LMi.net 1700 MLK Jr. Way, Berkeley, CA 94709

(510) 843-6389

(510) 843-6390 fax

Broadband Internet Service Agreement Template