Double Play Fiber Application

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DOB
Federal Employer Identification Number
Service Address
Mailing Address
Additional Applicant Name
Name
Additiional Applicant Cell #
 

Plan Options
$4.95 per month
$11.95 per month
*Additional Wiring Fee for Set top Box(s) $20.00 per location
Other Options - Contact Office for More Informatiton
Router Information
*Router purchased from Sirentel, comes with a 1year limited warranty. All prices subject to change.
$125.00 Installation Fee
Untitled
(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’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 repair and/or replacement of the modem. Upon termination of Double Play service Set Top Box(s) must be returned to the Siren Telephone’s business office or a $172.95 charge will be assessed. Fiber Modem stays at the residence.

Double Play customers will be assessed a monthly charge on their statement. Double Play service is billed one month in advance.

Install fees & 1st month of service is required before installation of service. All above plan prices are estimated all prices subject to change.
Date