Fiber Broadband Application Click Here to Download Application Siren Telephone Company: Applicant Name Applicant Cell #Driver's License (ID#) StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificDOB Month Day Year FEIN # Federal Employer Identification NumberAdditional Applicant Name Additional Applicant Cell #Service Address Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Township Mailing Address Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Login Name Preferred Email Address Broadband Speeds 30 Mbps $69.30 per month 50 Mbps $106.50 per month 100 Mbps $156.50 per month Higher Fiber Speeds Available Per Request (estimated prices, taxes & fees may vary) $125.00 Installation FeeUntitled Static IP Address $10.00 per month (The following items may require a Static IP: Security Cameras & VPN’s) Wireless Router Option D-Link Dual Band Eagle Pro AI Router onetime fee $87.50 Adtran 834-5 Dual Band Wireless Router onetime fee $191.00 Standard Wireless Router not purchased from Sirentel $32.00 programming fee Advanced Wireless Router w/App Based Setting, will require additional programming fee depending on model (call for more details). Customer Has Own Wireless Router, Customer Will Program (No Charge) *Router purchased from Sirentel has 1 year limited warranty. All prices subjected to change.Wireless Router Password (Must be 8 letters, no more than 12)Name for Wireless Router (or we will default to My Network)Router Admin Password (To secure your router settings)I, the undersigned, am requesting that Siren Telephone Company plow fiber optic to my premise. By signing the agreement, I agree to the digging that is required for service from Siren Telephone Company.Customer Signature Date Month Day Year CAPTCHA