Service Order Form |
Businesses: Please call our Sales Department for quotes on Telephone and Internet Services. 888-790-8101 |
This form should only be filled out by Property Owners. All services are subject
to the Terms And
Conditions.
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Customer Information |
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Lines |
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Packages |
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Local Phone Service, Unlimited Long Distance*, Lifeline Basic Cable Service***,
and Express Internet 30Mb/30Mb ($125.00) |
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Local Phone Service, Unlimited Long Distance*, Premier
Digital Cable Service**, and Advanced Internet 50Mb/50Mb ($145.00/month) |
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Local Phone Service, Unlimited Long Distance*, Premier Digital Cable Service**, 18 Starz and Encore channels, and Expert Internet 100Mb/100Mb ($160.00) |
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Local Phone Service, Unlimited Long Distance*, Premier Digital Cable Service**, 33 Starz, Encore, HBO, Showtime, and Cinemax channels, and Platinum Internet 200Mb/200Mb ($185.00) |
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Local Phone Service, Unlimited Long Distance*, Premier Digital Cable service**, 33 Starz, Encore, HBO, Showtime and Cinemax channels, and Express Internet (Add to nightly rental fee). |
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Broadcast ID:
Password:
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Unlimited Long Distance-Continental US Only |
** |
180 Digital Channels for one room & 56 Lifeline Basic Channels
in additional rooms with Digital TVs. Upgrade additional rooms from 56 Lifeline
Basic Channels to 180 Digital Channels @ $10.00/Month/Room for HD Service
(Lifeline HD Channels require an HDTV. National HD Channels require an HDTV
& HD Receiver). (Please note that Analog TVs without a Receiver
will only receive 25 of the 56 Lifeline Basic Channels. Upgrade Analog TVs from
25 Basic Channels to 56 Channels @ $10.00/Month/Room. |
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56 Lifeline Basic Channels on all Digital TVs. Analog TVs without
a Receiver will only receive 25 of the 56 Lifeline Basic Channels.
Upgrade Analog TVs from 25 Basic Channels to 56 Channels @ $10.00/Month/Room.
Lifeline HD Channels require an HDTV. |
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Individual Services (If No Package Selected) |
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Activation/Installation Charges Applicable As Outlined Below |
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Comments |
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By submitting I certify that I am at least eighteen years of age
and that I have read and understand the terms and conditions of this letter of
agency. I also certify that I am authorized to change or establish the services
indicated above for this location. I am further authorizing Procom to do a
credit check investigation and hold free from liability all creditors and other
persons who may respond to “inquiries”. |
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