Small Business Packages

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1 SMBS 110 South Hwy 86 P.O. Box 1006 Lakefield, MN Customer Information: (Please print all information) Rep Business Name: Contact Name: Contact Direct Phone: Contact Direct Service Address: PO Box: City: State: Zip Code: County: Business Daytime Number: After Hours Number: Business General Address: Billing Address (if different than above): Small Business Packages ( ) Business Basic 1-1 Phone Line and 15/5 Mbps Internet Service; perfect for the small business with less than 3 employees. Total Billable - Phone line includes free calling to all SMBS and Windomnet customers. - $75.95/month ( ) Business Basic 2-2 Phone Lines and 15/5 Mbps Internet Service; designed for the small business with 3-6 employees. Total Billable - Phone lines include free calling to all SMBS and Windomnet customers. - $99.95/month

2 Telephone Line Information: ~ Telephone ~ ( ) Line 1 (507) - ( ) Line 2 (507) - ( ) Line 3 (507) - Total Billable ( ) New Number Request ( ) New Number Request ( ) New number request ( ) Roll-over (Non-Published/Listed)+ ( ) Roll-over (Non-Published/Listed)+ ( ) Published: Free* ( ) Published: Free* ( ) Published: Free* ( ) Non-Published**$2.50/mo ( ) Non-Published** $2.50/mo ( ) Non-Published** $2.50/mo ( ) Non-Listed*** $1.25/mo ( ) Non-Listed*** $1.25/mo ( ) Non-Listed*** $1.25/mo * Free-Published: Name and number available in Directory and through Directory Assistance ** Non-Published: Name and number not available in Directory or given out through Directory Assistance *** Non-Listed: Name and number not available in Directory, but is available through Directory Assistance +Choose Line Hunting from Enhanced Calling Features below Additional Phone Lines (Not included in Service Package) - Each line includes toll-free calling to all SMBS and Windomnet customers. ( ) Additional phone lines (in addition to package) Price #_Lines $26.45 Total Billable $ Line 1 Directory Name Line 2 Directory Name Line 3 Directory Name Listed as: Listed as: Listed as: Address: Address: Address: ( ) Omit address ( ) Omit address ( ) Omit address Add l Listing (.50/mo) Add l Listing (.50/mo) Total Billable $ Long Distance Plans (make choice for each line) Line 1 Line 2 Line 3 ( ) Toll Free 800# :.12/minute (incoming only, no monthly fee) ( ) ( ) ( ) Toll Free 800# Plus:.06/minute and $3.95 monthly charge (66 minute break-even point) ( ) ( ) Total Billable $ ( ) Basic Long Distance:.10/minute ( ) ( ) ( ) Long Distance Plus:.06/minute and $1.99 monthly charge (50 minute break-even point) ( ) ( ) Total Billable $ ( ) No Long Distance ( ) ( ) Enhanced Calling Features (á la carte) Per billing period, per line charge. Price Line 1 Line 2 Line 3 Voice mail: $3.50 ( ) ( ) ( ) Total Billable $ Caller ID: (name & number will show on Caller ID units) $3.00 ( ) ( ) ( ) Total Billable $ Call waiting: (alerts you to an incoming call while on line) $2.50 ( ) ( ) ( ) Total Billable $ Call forwarding: (transfer all incoming calls to another location) $2.50 ( ) ( ) ( ) Total Billable $ Speed dialing: $2.50 ( ) ( ) ( ) Total Billable $ Selective call rejection: $2.50 ( ) ( ) ( ) Total Billable $ Busy call forward: $2.50 ( ) ( ) ( ) Total Billable $ SIM ring: $4.00 ( ) ( ) ( ) Total Billable $ Line Hunting: $2.95 ( ) ( ) ( ) Total Billable $ 3-way Calling/Call Transfer $2.95 ( ) ( ) ( ) Total Billable $ Enhanced Features Total $

3 ~ Internet ~ ( ) Business Internet 15M/5M $62.95 Total Billable $ ( ) Static IP Address $5.00 each/month Qty. Total Billable $ - Increase your Internet speed to fit your business needs ( ) Deluxe Add 10/5 to your Business Internet speed for $29.95/month Or ( ) Express Add 20/10 to your Business Internet speed for $59.90/month Total Billable $ Set-Up (up to 5 addresses) *Your login name(s) will establish your address(es) to use in all your Internet correspondence. Your login name(s) can contain a combination of lower case letters and/or numbers. Some examples of login names are and Your password should be at least 6 characters in length, and should contain both numbers & letters. ( ) Do not want to establish an address at this time.

4 Video Packages ~ Video Pricing ~ ( ) Basic Video $29.50 Our economic package offering 24 Channels, including local network affiliates Total Billable $ ( ) Expanded Basic $63.90 A diversified package offering 74 Channels, including local network affiliates, Total Billable $ Video super stations, popular sports, news information, and family programming. ( ) Digital Basic $86.60 An Expanded package including Basic, Expanded Basic, 58 additional Total Billable $ channels, and 30 music channels First set-top box is free with digital package; additional boxes are available for $7.95/month Add-ons for any digital video package*: ( ) HD Package $12.95 Total Billable $ ( ) HBO Package $16.95 Total Billable $ ( ) Showtime/TMC/Flix $14.95 Total Billable $ ( ) Starz/Encore $14.95 Total Billable $ Total Billable $ * Digital Packages require a set-top box. First set-top box will be provided at no charge. Additional Equipment Rentals: Set-top $0.00 (w/qualifying package) Add l set-top boxes (HD capable) $7.95/mo. - Qty HD DVR boxes $14.95/mo. - Qty Total Billable $ (DVR box does not qualify for free box) ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Additional Information ~ Standard/New Outlet Installation New outlets can be installed within the primary business location at the customer s request. The cost per outlet may vary. Due to the nature of inside wiring and the uniqueness of each location, it may not be possible to estimate the cost for installation. The charge for installation of the NEW outlets will be on a time and materials basis. Cost of materials will be determined at time of installation. Price shown below is for standard installation of new jacks. Routers for wireless internet usage can be purchased through your choice of retailer. Phone Jacks ( ) Additional new jacks $55.00 One Time Charge - Qty installed Total Billable $ Video: ( ) Install NEW outlets $55.00 Anticipated # of new outlets - Qty installed Total Billable $ VCR's/Stereo/Entertainment Systems/Game Consoles SMBS will not connect or provide the labor necessary to install these items. A customer that chooses to have these systems or similar ones connected is responsible for any parts, wiring, and labor necessary. SMBS will not provide any parts or wiring for the connection of electronics.

5 Service Package ~ Service Summary ~ Quantity ( ) $75.95/mo. Business Basic 1 ( ) $99.95/mo. Business Basic 2 ( ) $62.95/mo. Business 15/5 Internet ( ) $26.45/mo. Additional Phone Lines ( ) $29.95/mo. Deluxe or ( ) $59.90/mo. Express Additional a la carte features: Phone Internet Video Total * Above rates are monthly charges. Access fees and taxes will be added to monthly billings. Total Estimated Charges* One-Time Charges * Additional taxes and Franchise Fees may apply. Total monthly charges will vary with usage of long distance service, etc. Letter of Agency (Required for phone service, if porting number or numbers from another provider) I authorize Southwest Minnesota Broadband Service (SMBS) to act on my behalf as my agent to*: Transfer my local telephone service from to SMBS. Transfer my long distance service for calls within the 507 Area Code from to SMBS. Transfer my long distance service for calls outside the 507 Area Code from to SMBS. Current phone service provider is: Qwest (Century Link) Century Tel (Century Link) Frontier Other Long distance provider if not SMBS Name (Please Print) Phone number to be ported Address City: Signature Date * Authorization: We will contact your current phone provider on your behalf to transfer your service to SMBS. This makes changing to SMBS convenient since we make all the calls necessary for you to coordinate the phone service transfer with your current provider. Security Required Security Password CPNI Customer Proprietary Network Information choose a password up to 15 characters Suggestions: Mother s maiden name, favorite pet, favorite color Password Hint (we give to you should you forget what you told us) Acceptance I, the undersigned, request a Southwest Minnesota Broadband Account. I have received, read and agree to the Southwest Minnesota Broadband Service rates and request the services that I have identified in this service order form. I grant an easement and permission to SMBS to bury a service line onto my property for the express purpose of service delivery to solely my property.* Signed (Must be 18 years or older) Date (Must be signed by subscriber or co-subscriber listed above) *If business owner is not the owner of the property, landowner must sign drop permission slip. List any privately buried facilities on property, such as sprinkler systems, dog fences, etc. 4/15/15

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