Northwest Communications Application"*" indicates required fieldsStep 1 of 812%New Service LocationSelect A Service LocationAlbert City, IA - RuralAlbert City, IA - In TownAlgona, IAAlta, IAAurelia, IAAyrshire, IABode, IABradgate, IA - RuralBradgate, IA - In-TownBritt, IACherokee, IACurlew, IACylinder, IAEarly, IA - RuralEarly, IA - In TownEmmetsburg, IAFonda, IAGarner, IAGillett Grove, IAGilmore City, IA - RuralGilmore City, IA - In TownHavelock, IAHumboldt, IAJolley, IALake City, IALaurens, IALivermore, IALohrville, IALu Verne, IALytton, IA - RuralLytton, IA - In TownMallard, IA - In TownMallard, IA - RuralManson, IAMarathon, IA - RuralMarathon, IA - In TownNemaha, IANewell, IAOttosen, IAPioneer, IAPlover, IAPocahontas, IAPomeroy, IA - RuralPomeroy, IA - In-TownRockwell City, IARolfe, IARolfe, IA - RuralRutland, IA - RuralRutland, IA - In TownSt. Joseph - RuralStorm Lake, IA - RuralTruesdale, IAVarina, IAWesley, IAWest Bend, IAWhittemore, IA - RuralWhittemore, IA - In TownSelect your city to see what options are availableRolfe & WhittemoreInternet. Speeds depend on location.Residential Internet 25 or 50Mb*: $49.95 35 or 75Mb*: $64.95 45 or 100Mb*: $84.95 75 or 200Mb*: $144.95Business Internet 30 or 75Mb*: $64.95 40 or 100Mb*: $94.95 50 or 200 Mb*: $154.95Do you want an ncn.net email address? Yes No@ncn.net email option #1 Please have a password in mind for the email. Minimum 8 characters, maximum 512 characters. At least one uppercase letter, one lowercase letter, one number and one special character. Special characters allowed are as follows: @ - _ . $ , % & ! # *@ncn.net email option #2 Please have a password in mind for the email. Minimum 8 characters, maximum 512 characters. At least one uppercase letter, one lowercase letter, one number and one special character. Special characters allowed are as follows: @ - _ . $ , % & ! # *Requested WiFi Network nameNetwork name that will be visible to wireless devices. Please have a password in mind. Minimum 8 characters, maximum 512 characters. At least one uppercase letter, one lowercase letter, one number and one special character. Special characters allowed are as follows: @ - _ . $ , % & ! # *Telephone - SkyPhoneSkyPhone $19.95*Unlimited Long distance, Free cordless phone. NOTE: Please note that we do not recommend Skyphone for individuals who rely on phones for emergency services. Examples are life alerts/heart monitors/hog confinement alarms plus a $1.00 911 fee and state tax.* Additional fees and taxes total $22.42.dynamicTV provided by NICPResidential and BusinessBroadcast Basic: Includes 1 Whole Home DVR Broadcast Premium: Includes 1 Whole Home DVR & 1 Regular Receiver $72.68 + $5.09 tax Total $77.77 (price if you do not have our Broadband Internet) Additional Set Top Box: $5.00 + $0.35 tax Total $5.35Broadcast Basic Plus: Includes 1 Whole Home DVR $119.45 + $8.36 tax Total $127.81 (price if you have our Broadband Internet) $129.50 + $9.07 tax Total $138.57 (price if you do not have our Broadband Internet) Additional Set Top Box: $5.00 + $0.35 tax Total $5.35Broadcast Premium: Includes 1 Whole Home DVR & 1 Regular Receiver $129.45 + $9.06 tax Total $138.51 (price if you have our Broadband Internet) $143.18 + $10.02 tax Total $153.20 (price if you do not have our Broadband Internet) Installation of Additional Receiver: $40.00 + $2.80 tax Total $42.80* With Tax Included Cinemax: $15.52*/month Starz/Encore: $9.63*/month Showtime: $16.05*/month HBO: $18.73*/month* With Tax Included Set Top Box with Whole Home DVR: $15.52* Subscribe to 2 Premium Channels: Save $1.00/month Subscribe to 3 Premium Channels: Save $3.00/monthNumber ov TVSPlease enter a number from 0 to 10.Location of Each TVAge of Each TVDiscount/FeesReceive $5.00 off per month when you subscribe to more than one service (dynamicTV, telephone or Internet.)Inside Wire: $7.95/month (free 6 months)Installation Fee of $75.00 per service. If signing up for one or more service at this time, only one installation fee will be charged.Dynamic fee to install additioal boxes still apply.Moving to a new building, installation above will still apply.West Bend, Plover, Curlew, & HavelockInternet. Speed depends on location.Residential Internet 100 Mb*: $49.95 120 Mb*: $64.95 130 Mb*: $80.95 150 Mb*: $104.95 200 Mb*: $144.95*Internet rate if you also subscribe to telephone service. Some restrictions may apply. Speeds where available and subject to other services being provided at the location. Service is subject to current terms of use.Business Internet 120 Mb*: $64.95 130 Mb*: $94.95*Internet rate if you also subscribe to telephone service. Some restrictions may apply. Speeds where available and subject to other services being provided at the location. Service is subject to current terms of use.Internet OnlyResidential Internet Fiber 120 Mb $65.95 Fiber 130 Mb $84.95 Fiber 200 Mb $154.95Business Internet Fiber 120 Mb $87.95 Fiber 130 Mb $117.95Do you want an @ncn.net email address? Yes Noncn.net email option #1 Minimum 8 characters, maximum 512 characters. At least one uppercase letter, one lowercase letter, one number and one special character. Special characters allowed are as follows: @ - _ . $ , % & ! # *ncn.net email option #2 Minimum 8 characters, maximum 512 characters. At least one uppercase letter, one lowercase letter, one number and one special character. Special characters allowed are as follows: @ - _ . $ , % & ! # *Requested WiFi Network nameNetwork name that will be visible to wireless devices. Network name that will be visible to wireless devices. Please have a password in mind. Minimum 8 characters, maximum 512 characters. At least one uppercase letter, one lowercase letter, one number and one special character. Special characters allowed are as follows: @ - _ . $ , % & ! # *TelephoneTelephone Residential: $31.25 + taxes and surcharges Business: $37.50 + taxes and surchargeIncludes: Call Waiting, Call Forwarding, Three Way Calling, Speed Calling, Caller ID, Voice Mail, & Personal Access.Do you want long distance? Yes NoLong Distance Packages available with Local Alliance Network 60 Minutes of Local Alliance Network Long Distance FREE 120 Minutes of Local Alliance Network Long Distance $3.00 240 Minutes of Local Alliance Network Long Distance $5.00Name to Appear in DirectoryMembership Name/NamesFree Calling Features (check the options that you would like) Caller ID Name Call Forwarding Call Waiting on Caller ID Voicemail Call Reject Speed Dialing Caller ID Number Call Waiting 3 Way Calling Call Transfer Call ReturnWe automatically block 900 number calls and third caller billing. Do you wish to unblock? Yes NoWould you like voicemail to cell phone notification? Yes NoIf yes, Cell NumberPlease include the area codeCellular ProviderLong distance Yes NoDesidered Carrier, InterIntraAdditional Service Needs Large Print Bill Hearing, speech or condition that this disability/limitation prevents or limits ability to communicate over voice networks.Please describe the nature of the disability or medical conditiondynamicTV provided by NICPResidential & BusinessBroadcast Basic: Includes 1 Whole Home DVR $58.95 + $4.13 tax Total $63.08 (price if you have our Broadband Internet) $75.95 + $5.32 tax Total $81.27 (price if you do not have our Broadband Internet) Additional Set Top Box: $5.00 + $0.35 tax Total $5.35Broadcast Basic Plus: Includes 1 Whole Home DVR $119.45 + $8.36 tax Total $127.81 (price if you have our Broadband Internet) $129.5 + $9.07 tax Total $138.57 (price if you do not have our Broadband Internet)Broadcast Premium: Includes 1 Whole Home DVR & 1 Regular Receiver $129.45 + $9.06 tax Total $138.51 (price if you have our Broadband Internet) $149.15 + $10.44 tax Total $159.59 (price if you do not have our Broadband Internet) Installation of Additional Receiver: $40.00 + $2.80 tax Total $42.80*With Tax Included Cinemax: $15.52*/month Starz/Encore: $9.63*/month Showtime: $16.05*/month HBO: $18.73*/month*With Tax Included Set Top Box with Whole Home DVR: $14.98* Subscribe to 2 Premium Channels: Save $1.00/month Subscribe to 3 Premium Channels: Save $3.00/monthNumber of TVsLocation of each TVDiscount/FeesReceive $5.00 off per month when you subscribe to more than one service (dynamicTV, telephone or Internet.) Inside Wire: $7.95/month (free 6 months) Installation Fee of $75.00 per service. If signing up for one or more service at this time, only one installation fee will be charged. Dynamic fee to install additioal boxes still apply. Moving to a new building, installation above will still apply.Ayrshire & Gillett GroveInternet. Speed depends on location.Residential Internet 100 Mb*: $49.95 120 Mb*: $64.95 130 Mb*: $84.95 140 Mb*: $104.95 200 Mb*: $144.95*Internet rate if you also subscribe to telephone service. Some restrictions may apply. Speeds where available and subject to other services being provided at the location. Service is subject to current terms of use.Business Internet 120 Mb*: $64.95 130 Mb*: $94.95 200 Mb*: $154.95*Internet rate if you also subscribe to telephone service. Some restrictions may apply. Speeds where available and subject to other services being provided at the location. Service is subject to current terms of use.Internet Only$75 Install FeeResidential Internet Fiber 75Mb $65.95 Fiber 100Mb $80.95Business Internet Fiber 75Mb $87.95 Fiber 100Mb $117.95Do you want an ncn.net email address? Yes Noncn.net email option #1 Network name that will be visible to wireless devices. Please have a password in mind. Minimum 8 characters, maximum 512 characters. At least one uppercase letter, one lowercase letter, one number and one special character. Special characters allowed are as follows: @ - _ . $ , % & ! # *ncn.net email option #2 Network name that will be visible to wireless devices. Please have a password in mind. Minimum 8 characters, maximum 512 characters. At least one uppercase letter, one lowercase letter, one number and one special character. Special characters allowed are as follows: @ - _ . $ , % & ! # *dynamicTV provided by NICPResidential & BusinessBroadcast Basic: Includes 1 Whole Home DVR $58.95 + $4.13 tax Total $63.08 (price if you have our Broadband Internet) $78.95 + $5.53 tax Total $84.48 (price if you do not have our Broadband Internet) Additional Set Top Box: $5.00 + $0.35 tax Total $5.35Broadcast Basic Plus: Includes 1 Whole Home DVR $119.45 + $8.36 tax Total $127.81 (price if you have our Broadband Internet) $129.50 + $9.07 tax Total $138.57 (price if you do not have our Broadband Internet)Broadcast Premium: Includes 1 Whole Home DVR & 1 Regular Receiver $129.95 + $9.06 tax Total $138.51 (price if you have our Broadband Internet) $152.01 + $10.64 tax Total $162.65 (price if you do not have our Broadband Internet) Installation of Additional Receiver: $40.00 + $2.80 tax Total $42.80Number of TVsLocation of each TVDiscount/FeesReceive $5.00 off per month when you subscribe to more than one service (dynamicTV, telephone or Internet.) Inside Wire: $7.95/month (free 6 months) Installation Fee of $75.00 per service. If signing up for one or more service at this time, only one installation fee will be charged. Dynamic fee to install additional boxes still apply. Moving to a new building, installation above will still apply.TelephoneTelephone Residential: $28.00 + taxes and surcharges Business: $28.00 + taxes and surchargesIncludes: Call Waiting, Call Forwarding, Three Way Calling, Speed Calling, Caller ID, Voice Mail, & Personal Access.Do you want long distance? Yes NoLong Distance Packages available with Local Alliance Network 60 Minutes of Local Alliance Network Long Distance FREE 120 Minutes of Local Alliance Network Long Distance $3.00 240 Minutes of Local Alliance Network Long Distance $5.00Name to Appear in Directory First Last Address of previous home* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code We automatically block 900 number calls and third caller billing. Do you wish to unblock? Yes NoFree Calling Features (check the options that you would like) Caller ID Name Call Forwarding Call Waiting on Caller ID Voicemail Call Reject Speed Dialing Caller ID Number Call Waiting 3 Way Calling Call Transfer Call ReturnWould you like voicemail to cell phone notification? Yes NoIf yes, cell number:Please include the area code.Cellular providerLong Distance? Yes NoDesired Carrier, InterIntraAdditional Service Needs Large Print Bill Hearing, speech or condition that this disability/limitation prevents or limits ability to communicate over voice networks.Please describe the nature of the disability or medical conditionAlbert City - Rural , Algona, Alta, Aurelia, Bode, Bradgate - Rural, Britt, Cherokee, Cylinder, Early - Rural, Emmetsburg, Fonda, Garner, Gilmore City - Rural, Humboldt, Jolley, Lake City, Laurens, Livermore, LuVerne, Lohrville, Lytton, Mallard - Rural, Marathon - Rural, Manson, Nemaha, Newell, Ottosen, Pioneer, Pocahontas - Rural, Pomeroy - Rural, Rockwell City, Rolfe-Rural, Rutland, St. Joseph, Storm Lake - Rural, Truesdale, Varina, Wesley, and Whittemore - Rural.Internet Only. $75 Install Fee | Other speeds available, call for detailsType of Account Residential BusinessResidential Wireless Internet 15Mb $49.95/month 20Mb $64.95/month 30Mb $84.95/month 50Mb $104.95/monthBusiness Wireless Internet 30 Mb $84.95/monthDo you want an ncn.net email address? Yes Noncn.net email option #1 Network name that will be visible to wireless devices. Please have a password in mind. Minimum 8 characters, maximum 512 characters. At least one uppercase letter, one lowercase letter, one number and one special character. Special characters allowed are as follows: @ - _ . $ , % & ! # *ncn.net email option #2 Network name that will be visible to wireless devices. Please have a password in mind. Minimum 8 characters, maximum 512 characters. At least one uppercase letter, one lowercase letter, one number and one special character. Special characters allowed are as follows: @ - _ . $ , % & ! # *Skywifi & SkyphonePlease select your citySelect a CityAlbert City - In TownBradgate - In TownEarly - In TownGilmore City - In TownLytton - In TownMarathon - In TownPomeroy - In TownRutland - In TownSkywifi 100/20MG $49.95 120/20MG $64.95 130/20MG $84.95 150/20MG $104.95Free router and tech support.Skyphone $9.95*Unlimited Long distance, Free cordless phone. NOTE: Please note that we do not recommend Skyphone for individuals who rely on phone f emergency services. Examples are life alert/heart monitors/hog confinement alarms. plus $1.00 911 fee and state tax.Do you want to port your current number? Yes NoDo you want an @ncn.net email address? Yes No@ncn.net email option #1 Network name that will be visible to wireless devices. Please have a password in mind. Minimum 8 characters, maximum 512 characters. At least one uppercase letter, one lowercase letter, one number and one special character. Special characters allowed are as follows: @ - _ . $ , % & ! # *@ncn.net email option #2 Network name that will be visible to wireless devices. Please have a password in mind. Minimum 8 characters, maximum 512 characters. At least one uppercase letter, one lowercase letter, one number and one special character. Special characters allowed are as follows: @ - _ . $ , % & ! # *Applicant InformationEmail* Name* First Last Email of person submitting form if different from subscriber Business Name (for business accounts)Phone*Service Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Are you a current Northwest or Ayrshire customer? Yes NoIf yes, which services do you have? Telephone Service High-Speed Internet dynamicTVHow did you hear about us?Do you rent or own your property?* Own RentIf rent, please provide name & phone number of landlord:Billing Information (if different than service address)Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Customer Service AgreementNorthwest AgreementI understand and acknowledge that continued use of Northwest’s Service constitutes acceptance of the Terms of Service. Acceptable Use Policy and other important policies posted on Northwest’s website www.northwest.coop. I agree it is my responsibility to read these policies and comply fully with their terms. I further understand the policies and pricing of Northwest’s services may change from time to time upon 30 days notice. The service is provided on an ‘AS IS’ and ‘AS AVAILABLE’ BASIS WITHOUT WARRANTIES OF ANY KIND, EITHER EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO WARRANTIES OF TITLE OR IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. If service is cancelled, customer agrees to return equipment in working order within 10 business days or pay equipment charges.To request a copy of our Terms of Service, Acceptable Use Policy, Equipment Charges and other policies, call our Customer Service Department at 800-249-5251 or visit www.northwest.coop.Ayrshire AgreementI understand and acknowledge that continued use of Ayrshire’s Service constitutes acceptance of the Terms of Service. Acceptable Use Policy and other important policies posted on Ayrshire’s website www.ayrshireia.com. I agree it is my responsibility to read these policies and comply fully with their terms. I further understand the policies and pricing of Ayrshire’s services may change from time to time upon 30 days notice. The service is provided on an ‘AS IS’ and ‘AS AVAILABLE’ BASIS WITHOUT WARRANTIES OF ANY KIND, EITHER EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO WARRANTIES OF TITLE OR IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. If service is cancelled, customer agrees to return equipment in working order within 10 business days or pay an equipment charge of $100-$800.To request a copy of our Terms of Service, Acceptable Use Policy, Equipment Changes and other policies, call our Customer Care Department at 800-249-5251 or visit www.ayrshireia.com.Signature*Consent* I agree to the privacy policy.Date MM slash DD slash YYYY Special Instructions or Other InformationNote: Signing this order form and agreement indicates I accept and understand the Customer Service Agreement and the Standard Installation Terms. Please print name.*SignatureCAPTCHACommentsThis field is for validation purposes and should be left unchanged.Δ
