Internet Services Form

•  By filling out this form, you are committing to have internet services installed at the location listed for the prices listed.
•  You will be notified when the installation is scheduled. An adult will need to be at the location during the installation.

Full Name:   
Address:   
City:   
State:   
Zip Code:   
Own or Rent:   
Phone  Number:   
E-Mail:   
Service Choice:   
Add up to 10 Meg
Turbo Speed?  		 
Add VoIP
phone service?  		 
How did you hear
about  Microserv?  		     Name:
Current service:   


I agree that this is a 12-36 month contract, and that Microserv retains ownership of all equipment even after the contract period. I understand and agree that early cancellation will result in 100% of the remaining contract amount due and payable immediately.

I also hereby certify that I have authority or permission to have an antenna mounted on the outside of the property listed above.

By clicking below, I agree to all the terms and conditions listed above.