Residential Broadband Value Plan Application Click Here to Download Application Siren Telephone Company Broadband/Phone: Applicant NameApplicant Cell #Driver's License NumberStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificDOB Month Day Year FEIN # (Business Only)Federal Employer Identification NumberAdditional Applicant NameAdditional Applicant Cell #DOB Month Day Year Service Address Street Address City 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 State ZIP Code TownshipMailing Address Street Address City 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 State ZIP Code Login NamePreferred Email Address Local Telephone + Long Distance + Broadband-Residential Service Value Plan $88.91 / 300 min Long Distance FREE/ 50 Mbps Broadband Unlimited Classic Plan $99.47 / 500 min Long Distance FREE / 50 Mbps Broadband Unlimited Ultimate Plan $110.01 / 1,000 min Long Distance FREE/ 50 Mbps Broadband Unlimited (estimated plan prices, taxes & fees may vary)All plans below come with Free Extended Community Calling if with Sirentel *$125.00 Installation Fee Wireless Router Option ZyXel 3510- Dual Band Router (WiFi6) $181.00 onetime fee- No Remote Support Adtran 834-5 Dual Band Wireless Router onetime fee $191.00-*Remote Support Available General wireless router programming fee, not purchased from Sirentel $32.00 onetime 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 subject to change. Static IP Address $10.00 per month (The following items may require a Static IP: Security Cameras & VPN’s) Name for Wireless Router(or we will default to My Network)Wireless Router Password(Must be 8 letters, no more than 12)Router Admin Password(To secure your router settings)Switch Long Distance to Sirentel Sirentel Long Distance Wants No Long Distance ECC Calling Only *Customer Must Contact Long Distance Provider to Cancel Service Included with Each Plan Call ID Number Call Waiting Three Way Calling Call Forwarding Selective Call Rejection Selective Call Acceptance 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, https://sirentel.mystagingwebsite.com There is a monthly modem maintenance fee of $4.75, which covers the repair and/or replacement of the modem. Upon termination of Broadband service, the modem must be returned to the Siren Telephone’s business office or a $172.95 charge will be assessed. Fiber modem stays at residence. Broadband customer will be assessed a monthly charge on their statement. Broadband service is billed one month in advance. Install fees & 1st month of service is required before installation of service. All above monthly prices are estimated (All prices subject to change). Broadband speeds may vary by location.Customer SignatureDate Month Day Year CAPTCHA
