Northwest Communications Application - Mallard - In Town"*" indicates required fieldsStep 1 of 333%Mallard - In-TownInternet. Speeds depend on location.Residential Internet 100 Mb*: $49.95 120 Mb*: $64.95 130 Mb*: $84.95 200 Mb*: $144.95Business Internet 120 Mb*: $64.95 130 Mb*: $94.95 200 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.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. 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