Alsat Wireless Application for Service

Name of Business (if applicable)

First Name *

Last Name *

911 (Physical) Address *

Mailing Address (if different)

City *

State *

Zip Code *

Phone Number *

Mobile Number

Contact Email Address *

How did you hear about us?

Internet Service Plans

Residential Internet Plans 🛈

Basic - 1.5 Mbps/.5 Mbps (Enhanced Basic - 3 Mbps/1 Mbps where available) - $45

Light Streaming - 3 Mbps/1 Mbps (Enhanced Light Streaming - 6 Mbps/1 Mbps where available) - $60

Streaming - 6 Mbps/2 Mbps (Enhanced Streaming - 12 Mbps/2 Mbps where available) - $75

Power User - 10 Mbps/3 Mbps (Enhanced Power User - 25 Mbps/2 Mbps where available) - $90

Commercial Internet Plans 🛈

Advanced - 3 Mbps/3 Mbps (Enhanced Advanced - 6 Mbps/6 Mbps where available) - $75

Premier - 6 Mbps/6 Mbps (Enhanced Premier - 12 Mbps/12 Mbps where available) - $90

Elite - 10 Mbps/10 Mbps (Enhanced Elite - 25 Mbps/25 Mbps where available)- $105

Router Services-PLEASE REVIEW BOTH CHOICES CAREFULLY * 🛈

Bring your own Router - no upfront charge

Worry Free WiFi - $60 setup, $8.00 monthly

Alsat Voice

Prices shown reflect a bundle discount. Please add $5/month to any plan listed that is NOT bundled with Alsat Wireless High Speed Internet. Unless Worry Free WiFi is selected, a $60 + tax one time ATA device charge required on all non hosted services, with the exception of V-Fax service. Additional equipment necessary for all hosted services, contact us for further details. Taxes and fees additional.

Alsat Voice Residential 🛈

Residential Premier - $19.99

Alsat Voice Business (Non-hosted) 🛈

Business Basic - $29.99

Alsat Voice Business (Hosted) - Pricing is per station 🛈

Business Basic Hosted-includes 500 anytime minutes, .05/min. after - $24.99

Business Premier Hosted - unlimited usage - $34.99

Alsat Voice Fax Services 🛈

V-Fax Service (scanner required) - $10

Traditional Fax Service - $15.99

Number Porting Request (see note) 🛈

Yes, I have phone number(s) that I wish to port to Alsat Voice-numbers listed below

Phone Number (digits only, including area code)

Fax Number (digits only, including area code)

Credit Card Information (Required for ALL accounts)

Name on Card *

Credit Card Type *

Credit Card Number *

Expiration Date (mm/yy) *

Credit Card Security Code *

I HAVE READ THE SUBSCRIBER AGREEMENT, AND AGREE TO ITS TERMS. IN THE EVENT I HAVE ELECTED THE ELECTRONIC OPTION FOR PAYMENT, I UNDERSTAND AND AGREE THAT MY SUBSCRIPTION FEES WILL BE CHARGED TO THE CARD AUTOMATICALLY ON THE DUE DATE.

Please Sign Below. If using a smart phone or tablet, use your finger to sign. If using a computer, please use your mouse to sign.

*

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