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Home Telecom DSL SignUp

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First Name *

Last Name *

Title

Primary Contact Number *

Secondary Contact Number

Email Address *

Service Address *

City *

State *

Zip *

Unit

Your Neighborhood

Is your billing address different from your service address?

Yes, they are different.

No, they are not.

Billing Street Address *

Billing City *

Billing State *

Billing Zip *

Do you rent or own the property where you are looking for service?

Rent

Own

Landlord Name

Landlord Email

Landlord Phone Number

Service Options

Internet Options *

Package	Monthly Price
10 Mbps	$64.95
6 Mbps	$54.95
3 Mbps	$44.95

*All services/speeds not available in all areas. The speed available to you is dependent upon your distance from our equipment. Listed speeds are "up to” speeds and are not guaranteed.

Video Options *

Package	Limited Basic + Package	Monthly Price
Premium DSL Video	$12.95 + $167.00	$179.95
Essential DSL Video	$12.95 + $115.00	$127.95
Basic DSL Video	$12.95 + $81.00	$93.95

*Broadcast TV surcharge required for all video packages. - $17.87/month

Premium Movie Packages
Let us know which movie package you're interested in.

HBO

Cinemax

Showtime

STARZ/STARZ ENCORE

SECURITY & HOME AUTOMATION

Interested in Home Telecom's Security & Home Automation? *

Package as low as $24.99/month!
24-Hour Monitoring including fire monitoring. From arming and disarming to full home automation with your phone or wireless device.

Additional Information

How did you hear about Home Telecom? *

To assist our construction crew, please list any fences or buried facilities (geothermal lines, sprinkler system, etc.) on your property that would not be found during a standard locate.

Any comments or additional information that we should be aware of?

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Additional Information