Fiber Broadband Application

Click Here to Download Application

Siren Telephone Company: Applicant Name

Applicant Cell #

Driver's License (ID#)

State

DOB

FEIN #

Federal Employer Identification Number

Additional Applicant Name

Additional Applicant Cell #

Service Address

Street Address City State ZIP Code

Township

Mailing Address

Street Address City State ZIP Code

Preferred Email Address

Broadband Speeds

30 Mbps $66.50 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 Fee

Untitled

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

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