Basic Internet Wireless Connection Service Application
Name
First
Last
Are you currently a Basic Internet customer?
Yes
No
Physical Address:
Do you own or rent this home?
Own
Rent
Mailing Address:
Phone
Home
Work
Cell
Which number is the best to contact you during the day?
Home
Work
Cell
Type of Building:
Brick / Block
Mobile home
Modular Home
Wood frame
Number of stories
1 story
1 story on stilts
2 stories
2 stories on stilts
Other
Siding Material:
Vinyl
Brick / Block
Metal
Other / Don't Know
Inside wall type:
Sheetrock
Paneling
Wallboard
Other / Don't Know
How many computers do you have?
For your primary computer:
Laptop or Desktop?
Does it have an ethernet (network) card?
What Operating System?
What Antivirus software are you using?
Do you have any security or firewall software? If so, what?
Laptop
Desktop
Yes
No
Apple/Mac OSX
Apple/Mac Older
Windows 98
Windows 2000
Windows ME
Windows XP
Windows XP SP1
Windows XP SP2
Windows Vista
Older Windows
Other
Don't Know
AVG
Norton
McAfee
PC-Cillian
F-Prot
Other
None
Don't Know
Do you currently have a network, or will you need us to help you connect your computers to each other?
Are you going to want your computers to be wireless (wi-fi) inside the house?
If so, are they already wi-fi equipped, or will you need additional equipment? [There may be additional costs for wi-fi equipment if you require parts.]
If you have more than one computer:
Will you be paying by charge card, or by invoice?
If you are going to have wireless computers in your house, do you already own a wi-fi acess point, or would you like to puchase one from us?
Yes, I have a network
No, I will need help
I will not need a network
Yes
No
n/a
already equipped
need equipment
n/a
already have one
need equipment (will purchase from you)
need equipment (will need advice from you)
n/a
Charge
Invoice
NOTE:
Standard $50 installation fee covers normal installation of the fixed-wireless receiver. It will not cover any parts for the computer(s) or network configuration. Installations requiring additional time or materials for cabling, drilling, or unusual situations may be subject to an additional charge. Any such charges will be explained to the Customer prior to the beginning of work and will be charged to the next Internet bill. Multi-computer network setup and configuration may possibly require a separate site visit as well as labor and material charges. Due to the danger of virus activity on the network, we will require a current working antivirus program to be installed on any computer connected to the Internet through our Service. If you do not have one, please let us know and we will help you acquire one.
Static IP:
Although most Customers do not require the use of a static IP address, those Customers who request a static IP address agree to pay an additional $10 per month for the use of each static IP address requested. If you need a static IP address, please initial here:
Please Note:
Our radios operate on a 900 MHz frequency. Some cordless telephones use this frequency as well and may cause interference with the Internet connection. Basic Internet is not responsible if the customer's telephone equipment interferes with the high-speed signal.
By clicking the 'Submit Application' button, you
agree that you have read and agreed to the Basic Internet Internet Access Service Agreement (
click here to read it
)
.