Name: *

First Name

Last Name

Phone Number: *

(###)

###

####

Preferred Install Date: *

We will do our very best to accommodate your preferred install date.

MM

DD

YYYY

Select Internet Speed: *

*a cost recovery fee (CRF) will be applied to your monthly bill. Speeds guaranteed when hardwired to device.

300 Mbps at $44.99/month*

100 Mbps at $29.99/month*

50 Mbps at $24.99/month*

Internet Router/Modem Lease or Purchase: *

Please select the modem leasing option that best fits your needs or let us know if you have your own modem.

Smart Care Single Play for $11.99/month. This Smart Care Package includes a leased modem and any potential service calls.

Smart Care Bundle for $16.99/month. This plan is for both Internet and Video customers, and includes Single-Play benefits, install discounts, and more!

Purchase Modem from CSS for a $200 one-time cost.

I will use my own modem. (Troubleshooting and truck roll fees may apply.)

Are you interested in phone service? *

Phone Service starting at $24.99/month. *Taxes and fees may apply.

Yes.

No, not at this time.