Step 1 of 6 16% Which services are you interested in? (Check all that apply)* Internet TV Phone Applicant InformationName* First Middle Last Utility Account # Service Address* Phone*Email* Will there be a spouse / co-applicant?* Yes No Spouse / Co-Applicant InformationName* First Middle Last Phone*Email* Existing Utility Service InfomationDo you own or rent?* Own Rent Landlord's Name* Landlord's Phone*Service Location* Inside City Limits Outside City Limits Electric Services* Aerial Underground Electric Meter Location* On Home On Pole Approx. Pole Distance to Home* Internet ServiceSelect Speed* 100 Mbps ($44.95) 250 Mbps ($64.95) 1 Gig ($104.95) TV ServiceSelect Channel Package* Basic ($19.95) Standard ($74.95) Enhanced ($89.95) Digital Tier Options Sports Tier (18 Channels–$5.95) Latino Tier (10 Channels–$5.95) Premium Channel Options* 1 Premium Channel ($14.95) 2 Premium Channels ($26.95) 3 Premium Channels ($36.95) 4 Premium Channels ($46.95) None Select Premium Channels* Cinemax Starz & Starz Encore Showtime/TMC HBO How Many HD-DVRs would you like?*The first is FREE. Additional units are $9.95 each.How Many High Definition (HD) boxes would you like?*Units are $5.95 each. Phone ServiceNUconnect Phone for $32.95* I'd like to keep my existing home number Please assign a new number Includes Unlimited Local & Long Distance Calling (taxes and fees included)Please include the following features: Include All Voicemail Call Return Caller ID (Name & #) Call Forwarding Call Blocking Call Waiting Your existing phone number* CAPTCHA
