INTERNET APPLICATION FORM – RESIDENTIAL CUSTOMERS …

1 INTERNET APPLICATION form RESIDENTIAL CUSTOMERS BLOOMER telephone company 1120 15th Avenue Bloomer, WI 54724 Voice 715-568-4830 / Fax 715-568-4850 YOUR NAME _____ DATE _____ ADDRESS _____ telephone NUMBER (715) 568- _____ OR CONTACT NUMBER _____ SERVICE(s) REQUESTED: REGULAR RATES FOR HIGH SPEED INTERNET : _____ $ per month for 1 Mbps speed service (additional speed available see rates below) _____ $ per month to lease router covers router maintenance and replacement _____ $ per month to lease wireless router covers router maintenance and replacement _____ Using customer owned equipment - no monthly charge does not cover maintenance or replacement customer will be billed hourly rate for any maintenance on customer owned equipment.

2 PACKAGE RATES: _____ $ Local Phone Service + High Speed (1 Mbps) INTERNET Package _____ $ Local Phone Service, Long Distance + High Speed (1 Mbps) INTERNET Package _____ $ Fiber Speed Home Package (phone, long distance & 15 Mbps INTERNET ) _____ $ Fiber Speed All-in -one Package (phone, long distance, TV and 30 Mbps INTERNET ) _____ $ per month for wireless INTERNET covers router maintenance and replacement _____ Using customer owned router for wireless INTERNET - no monthly charge does not cover maintenance or replacement customer will be billed hourly rate for any maintenance on customer owned equipment. ADDITIONAL SPEED: Quotes for speeds above 60 Mbps are available upon request.

3 _____ $ per month to upgrade from 1 Mbps to 3 Mbps _____ $ per month to upgrade from 1 Mbps to 6 Mbps _____ $ per month to upgrade from 1 Mbps to 15 Mbps _____ $ per month to upgrade from 1 Mbps to 30 Mbps _____ $ per month to upgrade from 1 Mbps to 60 Mbps _____ $ per month to upgrade from 15 Mbps to 30 Mbps _____ $ per month to upgrade from 15 Mbps to 60 Mbps _____ $ per month to upgrade from 30 Mbps to 60 Mbps