Copper Broadband Application

DOB
Federal Employer Identification Number
Service Address
Mailing Address

Broadband Speeds:

2 Mbps $53.00 per month (estimated, taxes & fees may vary)
$99.00 Installation Fee

Wireless Router Option
*Router purchased from Sirentel has 1 year limited warranty.
(Must be 8 letters, no more than 12)
(or we will default to My Network)
(To secure your router settings)

I, the undersigned, am requesting a Siren Telephone Company’s Internet Account. By signing the agreement, I agree to the terms and conditions detailed in the policies found on Siren Telephone’s website, http://www.sirentel.com

There is a monthly modem maintenance fee of $4.75, which covers the diagnosis, repair and/or replacement of the modem. Upon termination of Broadband service, the modem must be returned to the Siren Telephone Company’s business office or a $150.00 charge will be assessed. A $99.00 charge for early termination plus number of months left of 6-month connection will be accessed.

Broadband customer will be assessed a monthly charge on their statement. Broadband service is billed one month in advance. Install fees & first month of service is required before installation of service. Installation Fee $99.00 All above monthly prices are estimated (All prices subject to change). Broadband speeds may vary by location.
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