DSL Application Form - SDC Internet

1 Page 1 of 2 DSL Application FormContact, Us ernam e, and Em ail I nf orm ation:722 N California StSocorro, NM 87801 Phone: (575)-838-1620(866)-838-1620 Fax: (801)-365-8330 Name: Business: Address 1: Address 2: City: State: ZIP: Phone #: Fax #: To use the service, you must specify a username.

2 This is the username that you will use to dial-up to our service andit will be your primary email address the email address that your billing notifications and other important SDC notices will be sent to. For example, if you want your username to be bob , your email address will be .Us er n a m e s can only be lowercase, alphanumeric (letters & numbers), must start with a letter, and cannot be longerthan 20 characters. If the username you request is already in use you will be notified so you can make another a sswo r ds can be any length and can consist of any key you can enter on the keyboard.

3 To help keep your account secure we require that passwords be at least 6 characters, must be a combination of letters, numbers, or symbols, andmust not contain common names or English words. For example, bi r d is not a valid password, but b1 r d_ # is. Do not use a password that is the same as the password you use for any other account or you would like SDC to host up to four free additional email addresses as well, please fill them in : Password: Email Address #2: Password: Email Address #3: Password: Email Address #4: Password.

4 Email Address #5: Password: Account Type(Check One:)MonthlyQuarterlyAnnualT y pe o f Serv i ce: Internet Service over DSL can be purchased either Monthly, Quarterly (due every three months), or Annually (once a year). You can switch from one billing-period to another at any time by contacting our office. Home$ $ $ 3-7 Mbps Home$ $ $ e follow in g are line and modem ch arges f rom CenturyLink for DS L service.

5 Th ey will b ill you sep arately on you r p hon e b ill:What speed service do you want to purchase? 1536kbps / 864kbps ($28/month) (local phone service required) 3-7 Mbps / 864kbps ($38/month) (local phone service required) I want a standalone DSL Line (no phone service, just DSL) 1536kbps / 864kbps ($33/month) I want a standalone DSL Line (no phone service, just DSL) 3-7 Mbps / 864kbps ($43/month)These prices are correct as of January 1, 2014. CenturyLink often have promotional prices andif these are available you will be advised of the terms and conditions of these as you be purchasing or renting your DSL modem from CenturyLink?

6 Purchase ActionTec PK-5000 or Zyxel PK-5000Z ($ + $ S&H) Purchase ActionTec PK-5000 or Zyxel PK-5000Z (3 payments $ + $ S&H) Lease ActionTec PK-5000 or Zyxel PK-5000Z ($ + $ S&H one-time) Already have a CenturyLink-compatible DSL modem (No additional charge)In signing below, I certify that the above information is correct and that I agree to abide by the terms and conditionsof the TERMS OF SERVICE AND ACCEPTABLE USE POLICY, a copy of which I have received. I also understand that failure to abide by those terms and conditions may be cause for termination of service.

7 Furthermore,I understand that I will be responsible for the purchase and maintenance of my own routing, connectivity and storageequipment and software : Date: SSN*: Birthdate*: (* Social security number and birthdate are used for credit purposes. If you chose not to provide this information your account may be suspended immediately without notice if payment for subsequent periods of service is not received promptly on the due date.)

8 Copyright SDC Internet 2015 Document DSL-2015_03_10