STARNET WIRELESS - SERVICE ORDER REQUEST

***Please provide all information and check for accuracy to ensure proper processing of your service order***
***Make sure to provide a complete address including direction, street type, and any apartment or unit number if applicable***

TERMS AND CONDITIONS: This agreement is made between you (the "customer") and StarNet Wireless LLC (the "company") effective upon completion of the service order. The customer agrees to the monthly service fee and any promotional pricing/term as stated on the company's web site. There may be administrative fees, taxes, or surcharges which typically range between two and three dollars. A service order activation charge will apply and current activation charges are nineteen dollars for residential and forty nine dollars for businesses. The customer agrees to pay the company for all charges billed within the due date stated on the invoice or late fees may be charged.
First Name *
Last Name *
Business Name (if applicable) *
Physical Address *
City *
State *
Zip Code *
Billing Address *
City *
State *
Zip Code *
DSL Telephone Number *
Contact Telephone Number *
Alternate Telephone Number *
Email Address *
Where did you hear about us? (please select a source) *
Speed Requested *
Have you reviewed all information for accuracy and agree to the terms and conditions of service? * YES
NO
Notes or Comments
  




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