1 WISPER HIGH SPEED INTERNET APPLICATION CUSTOMER INFORMATION Billing Name: Contact Phone Number: Contact Name: Alt. Contact Number: Billing Address: City: ST: Zip Code: 911 Address: City: ST: Zip Code: Contact Address: Do you rent at this location? Yes No If renting, provide name of landlord/property owner & contact number: How did you hear about Wisper High Speed? Newspaper TV Ad Radio Billboard Internet Yellow pages Friend Other: CREDIT INFORMATION Previous Address (Required): Applicant #1 Name: Date of Birth (Required): Applicant #2 Name: Date of Birth (Required): WISPER HIGH SPEED PLANS Residential Plans 384k / 256k $34.95/mo. 768k / 384k $44.95/mo. 1.5M / 512k $54.95/mo. $ No Service Agreement $75.00 w/18 Mo. Service Agreement Includes: 5 Accounts 5 MB of Disk Storage Standard Business Plans 384k / 384k $39.95/mo. 640k / 640k $49.95/mo. 1M / 1M $59.95/mo. $ No Service Agreement $75.00 w/18 Mo. Service Agreement Includes: 5 Accounts 5 MB of Disk Storage Premium Business Plans 1.5M / 1.5M $99.95/mo. 3M / 3M $149.95/mo. $ No Service Agreement $ w/18 mo. Service Agreement Included: 10 Accounts 10MB of Disk Storage Custom Packages: if your business requires large amounts of bandwidth, Wisper High Speed can custom build a package to suit your specific needs. We can deliver dedicated data rates and bandwidth up to 6M or more on a case by case basis. We would be happy to come to your place of business, discuss your needs and assess your situation, and give you a no obligation quote. OFFICE USE ONLY: Account Number: Install Date: Time: B/D: (MTC / MSC / WWS): Deposit Requested: Paid: Rec d: CSR: Notes: Revised:
2 INFORMATION Addresses: You must choose at least one address. Addresses must be 4 to 16 characters, using numbers and/or letters, hyphens, periods or underscores. * Residential and Business Plans receive 5- addresses * Premium Business Plans receive 10 addresses REQUIRED: Address Address Address Address Address Address Address Address Address Your password will be provided to you at the time of installation and can be changed by you at anytime via our website. COMPUTER INFORMATION Customers must have a NIC / Ethernet card in your computer(s). If you do not have a NIC card(s); these can be purchased from Wisper and installed by our tech at time of initial installation. Please call our office for pricing. Prices and availability are subject to change. Note: Additional time may be required. I have a (NIC) / Ethernet Card. I am not sure if I have a (NIC) / Ethernet Card. I need a (Nic) / Ethernet Card Operating System: Windows 2000 Windows XP Windows Vista Windows 7 Macintosh OS: Other: Number of Computers: Number of Desk Computers. Number of Laptop Computers. Note: Router is needed if you are connecting 2 or more computers and/or would like to use Internet wirelessly within your home. OPTIONAL EQUIPMENT Wireless Router: We have wireless routers available to purchase. A wireless router in your home or office will provide mobility for laptops, make it easier to move your desktop computer later if you choose, and allow you to network multiple computers. We will install and configure your wireless router as part of the standard installation. Additional time may be required if you wish to have us network multiple computers. Purchase $ tax Lease to $4.95/mo. for 18 months Provide Own Router No Router Needed Note: If you are providing your own router, Wisper can set up your router for $25.00 at time of installation. Asoka Plugs: Allows you to create a network through your existing electrical wiring in your home or office. Eliminates the hassle of extra cabling and makes it easier to relocate your desktop computers to any room you want. Plugs are sold individually. 2 plugs are required. For pricing, please contact our business office. OPTIONAL SERVICES Web Services If you would like to learn more about these additional services. Please contact our business office.
3 ACCOUNT PASSWORD SET UP-REQUIRED Due to the new CPNI FCC rules, if you request information about your account, you must supply the below password before the information can be disclosed. If you don t remember the password, the backup security questions below will be used for verification and a new password can be established. If a password can not be supplied, there are only a few ways mandated by the FCC in order to obtain the information: Have the Customer Service Representative (CSR) call you back, but only at the telephone number of record. Have the CSR mail you the requested detail information, but only to the address of record. You, the authorized account contact, must come in to the business office and show your valid government issued photo ID. One Form must be completed per account; therefore if there are more than one authorized account contacts on the account, this password will be for all authorized account contacts. PASSWORD: Note: The password can not be historical or biological information such as your social security number, address, mother s maiden name, etc. The FCC is trying to minimize the possibility of false identification for supplying account information, therefore do not use anything that someone else would be able to access. BACKUP SECURITY QUESTIONS: Choose two security questions and fill in the answer. This will be used to verify you as the authorized customer if the password can t be remembered. Once you answer the question(s) to our CSR, a new password can be reestablished. (If your password is ever changed, you will receive a Notice of Change/Activity at the address of record from our office. The notice will inform you of such change or activity and if this is not made by the authorized person, please contact our office immediately). 1. What is your favorite season? 2. What is your favorite color? 3. What high school did you attend? 4. What was your first childhood pet s name? 5. What is the month and day of your father s birthday? AUTHORIZED ACCOUNT CONTACTS To comply with the new FCC rules regarding Customer Proprietary Network Information (CPNI) we can only discuss certain account information with such authorized contacts. Please list below the name(s) of whom you would like to add as Authorized Contact(s) to your account at this time: Main Authorized Account Contact: Additional Authorized Account Contact: Additional Authorized Account Contact: *Anyone listed in the billing name will be an Authorized Account Contact and will have permission to access CPNI information on your account.
4 SERVICE AGREEMENT-SIGNATURE REQUIRED Please read and sign application for service. This application becomes a contract when accepted in writing by Wisper High Speed Internet. (I certify that I am at least 18 years of age). I certify that the information stated in this application is true and correct to the best of my knowledge. I authorize Wisper High Speed to check my credit; a deposit may be required. (A copy of your credit report is available upon request.) Internet Terms: If I entered into contract and terminate this agreement before the end of the contract date, I understand I will be charged a cancellation fee of $ I understand that upon termination of the agreement for any reason, I am and will remain liable for payment of all charges due. The undersigned appoints as limited agent to order and make changes in service associated with the activation of Wisper High Speed Internet as specified above. As an accepted Internet access user through the Wisper High Speed Internet (Wisper) network, I agree to abide by the present and future rules and bylaws of Wisper including the Acceptable Use Policy. I agree to follow the rules of any connected networks if and when using those networks. I recognize that Wisper offers no guaranty or warranty on the performance of its network and Internet connections, nor on the performance of gateway connections to other networks. I agree to hold Wisper and their officers, directors and agents harmless from any profits arising from special, indirect, or consequential damages including but not limited to lost profits, loss of opportunity, or any other loss which may result from the use of, misuse of, or lack of availability of Wisper and or their facilities. I further agree that regardless of the basis on which I may claim to be entitled to recover damages from Wisper (including fundamental breach, negligence, misrepresentation, or other contract or tort claim). Wisper will be liable for no more than (1) damages for bodily injury and (2) the amount of any other actual direct damages not to exceed the charges for the product or service that is subject of the claim. Equipment Information: As a consumer of Wisper High Speed Internet you agree that the equipment has been delivered and installed at your address as reflected in our business records. You agree not to remove it from that address except to return it to us. At the time we installed the equipment we: (1) demonstrated that the equipment was functioning properly; (2) instructed you in its use; (3) provided you with a copy of the Wisper High Speed Internet Acceptable Use Policy. You agree to take reasonable care of the equipment and agree not to open the equipment, take apart, or alter it in any way. You are responsible for all damage to the equipment, beyond reasonable wear from normal use, which occurs before you return or surrender it to us. The equipment must be returned in a fully usable condition. Except for damage caused by misuse or abuse, if you notify us of equipment failure, we will repair it or exchange it for properly functioning equipment. You agree to allow us to enter your installation address, at any reasonable time, to inspect, repair, replace, or remove the equipment. All equipment, not purchased, shall remain the property of Wisper High Speed Internet. I understand that if I am renting/leasing equipment, during this time Wisper High Speed Internet will maintain the equipment. Wisper High Speed Internet will not be responsible for any special, incidental, or consequential damages for loss, damage of expense directly or indirectly arising from the customer s inability to use the equipment nor will they be responsible for any damages caused to the equipment due to customer negligence. I will be liable for any charges to repair the equipment. Important: While leasing equipment, please keep all boxes, paperwork, CD s, etc for the equipment. Billing of Service: Installation charges (excludes special wiring & equipment), partial month of service and first full month of service will appear on your first bill. (All charges are subject to change.) A minimum of one month s service will be charged on all services. 30 Day Policy: I understand that if I am not completely satisfied with in the first 30 days of the service, I will be able to cancel my service and the terms under the service agreement shall be null and void and I will not be subject to the cancellation fee. Authorized Account Signature: Date: / / I understand by signing this agreement, that if I am not at location at time of installation, CPNI (Customer Proprietary Network Information) may be given to person(s) at location. A responsible adult must be at location during installation.
5 AUTOPAY I authorize Wisper High Speed Internet and the financial institution name below to initiate entries to my checking/savings account or credit card. This authorization will remain in effect until I notify Wisper High Speed Internet in writing at least 30 days before or prior to the date I wish to cancel automatic payment service. I understand that Wisper High Speed Internet will discontinue this service if I have two payments returned due to insufficient funds during a 12-month period. Reminder: If you sign up for Autopay with a credit card and get a new credit card or the expiration date changes be sure to notify Wisper with the new information to avoid any delays in processing your payment. Name of Financial Institution : : Routing Number located in the lower left of your check Account Number PLEASE attach an unsigned check marked VOID with complete account number and financial institution name indicated. Checking Savings Card Type (please circle): Card Number Expiration Date / / V Code (Last 3 digits on back of card) Print name as it appears on card Authorized Account Signature Date / / (Sign here for Auto pay) Business office use only: Date Rec d / / Date Entered / / Telephone Number By
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