Application for Wireless Internet ServiceFirst Name *Last Name *Installation AddressAddress Line 2Village/CityLocationSelectEBDECDWCDWBDWCBECBGEORGETOWNSelectPhone Number *Mobile Number *Email Address *Billing Information (If Applicable)Billing First NameBilling Last NameCompany NameBilling Phone NumberBilling Mobile NumberService InformationConnection Type *ResidentialBusinessChoose Package *SelectStarter | GYD 5300 /MO | Plus Installation costExtreme | GYD 7000 /MO | Plus Installation costExtreme+ | GYD 10500 /MO | Plus Installation costSelectSpecificationsAre you the Legal Owner of Land/Property ?Land Owner/Property OwnerI'm leasing/RentingPlease confirm that permission will be granted to install an Antenna on rooftop.I am fully aware that a wireless antenna will be installed on Rooftop and hereby grant access.I am unable to grant permission at this time.If you are Leasing/Renting, please let us know which floor you are residing on?First FloorSecond FloorThird FloorFourth FloorHow Did you Hear About Us ?Facebook/InstagramNewspapersFamily/FriendUpload IDUpload IDChoose FileNo file chosenDelete uploaded fileAgreementBy signing this Contractual User Agreement Policy you have read and fully understand the contractual terms and will act in compliance with the terms as set out above. Policy PageI agree to the Above User Agreement Policy *I agreeDate *Signature Name *Your Signature *Start signing your signature hereYour browser does not support e-Signature field.Submit
