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Contact Information
* Requestor's Name:

* Contact Phone Number

* Home Phone:
Alt. Phone:
* Email Address:
Best time to contact:
Do you currently have FiberNet Service?
How did you hear about the FiberNet residential Offer?
If other, please describe:
Promotion Code:
Referred by:

Service Location Information
* Service Contact Name:
* Street Address:
* City:
* State:
* Zip Code:
* Phone Number:
Billing Information
Billing Contact Name:
Street Address:
City:
State:
Zip Code:
Phone Number:

Select your desired Plan or Options

Local Calling Plan

Qty:

No Hassle or Charge to Change*
Monthly Charge: $34.95**
 
  • $.06/minute long distance
  • Voice Mail
  • Call Waiting
  • Three-way calling
  • Caller ID (Number)
  • Call Forwarding
         

Statewide Calling Plan

Qty:

No Hassle or Charge to Change*
Monthly Charge: $49.95**
 
  • Unlimited in-state long distance
  • $.06/minute State-to-State long distance
  • Voice Mail
  • Call Block
  • Call Waiting
  • Three-way calling
  • Caller ID (Number)
  • Anonymous Call Rejection
  • *69 Return Call
  • Repeat Call
  • Ultra Call Forwarding
         

Nationwide Calling Plan

Qty:

No Hassle or Charge to Change*
Monthly Charge: $57.95**
 
  • Unlimited in-state long distance
  • 700 minutes Nationwide calling.****
  • Voice Mail
  • Call Block
  • Call Waiting
     
  • Three-way calling
  • Caller ID (Number)
  • Anonymous Call Rejection
  • *69 Return Call
  • Repeat Call
  • Ultra Call Forwarding
   
         
DSL Internet Access Qty: Monthly Charge: $34.95
 
  • Service not available in all areas
  • Unlimited Internet Access
  • Speed up to 768K
Dial Up Internet Access Qty: Monthly Charge: $9.95***
 
  • Unlimited Internet Access
  • 24x7 Technical Support
  • 56k v.92 Digital Modems
  • Up to 5 email accounts

Save 10% off your monthly bill when you receive more than 1 service.
 (Dialup excluded)
Current Telephone Provider:

* Installation fee of $75-$150 and/or a deposit will apply for new line installations only.   
** Plus any applicable taxes or fees.
*** $9.95 Internet bundle price available only with telephone service, Regular Price $19.95
**** Any Nationwide LD exceeding the 700 minutes will be billed at our $.06/minute rate.


I agree to the terms & conditions of FiberNet, LLC Service Agreement for Residential Service.

Name:   Date:


Terms and Conditions:
By completing this form on FiberNet's website, you give FiberNet permission to access your current provider's records. You give FiberNet permission to contact you to verify the information provided in connection with your order using the contact information above. Other terms and conditions may apply.
Privacy Policy:
FiberNet respects your privacy. The information above is stored by FiberNet and used for Official FiberNet business only. Your personal information will never be knowingly shared or sold to any third party under any circumstances. FiberNet may use or make public general information (city, state, number of lines, etc) collected via this form for measurement purposes. Under no conditions will any identifying or personal information (name, address, telephone numbers, etc.) be released.

 

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