Airxcess Broadband Services

IMPORTANT: Please download and read this Subscriber Agreement before submitting this form. Once you submit this Activation Form; you are agreeing to the terms and conditions of the Subscriber Agreement and to the Information provided on this Activation Form and both items become your legal and binding contract for services.

Subscriber Agreement 1-2010

Prior to your scheduled installation, please complete the below form ONLY if you have been notified that you can receive our services. Please read the Subscriber Agreement in full to assure the proper activation of your account. Current Subscribers should renew their contract prior to their anniversary date of their original agreement. Renewal assures that you are protected under the equipment protection warranties and service plan rates. If your anniversary date is not posted on your invoice, call us and we will provide it to you. Make sure you provide us with your current Credit Card information in the event your card number or expiration has changed. Please call 315-531-8298 with any credit card information.

*(denotes required field)

Name: *

E-Mail Address: *

Account Renewal Only

Company Name

Physical Street Address *

City *

State *

Postal Code *

Billing Address same as above

Billing Street Address or PO Box

City

State

Postal Code

Phone Number (10 digit) *

Select Your Service Plan: *

Residential Basic - $32/mo. Standard Residential Plan - $42/mo. Residential Plus Plan - $52/mo. Residential Premium Plan - $72/mo. Residential Seasonal Plan - $47/mo. Commercial Basic Plan - $61/mo. Commercial Plus Plan - $91/mo.

Static IP Address - $10/mo.

Symmetrical Service - $19/mo.

Non-Refundable Installation Fees: *

Standard Residential - $199.95 Standard Commercial - $249.95 900mhz Installation Fee - $249.95 Account Renewal Only - Fee does not apply.

Maintenance Protection Plan - included in all plans @ $2.00/mo. (Required) *

Billing Cycle: *

Monthly Billing Quarterly Billing Annual Billing

Payment Type: *

VISA MasterCard Discover Local Check

Credit and debit cards are processed the first of each month of the billing cycle. You will not receive an invoice on credit and debit accounts. Your credit card or bank statement shall be your receipt of your payment. Credit card information will be taken over the phone for security reasons. *

PLEASE NOTE and CONFIRM: Airxcess provides services distributed by wireless links between our sites and your location. Please understand that wireless transmissions are subject to interference and foilage growth and some weather conditions. We cannot and do not guarantee 100% coverage and connection speeds. Speeds will vary with condions and network traffic. Checking this confims I have read and agree to this disclosure. *

I have downloaded and read the attached Subscriber Agreement (.pdf) and hereby agree and understand all conditions stated within that agreement. I affirm the same by the submission of this Activation Form and Agreement. *

CAPTCHA Code: *