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Telephone -- Cable TV -- Internet -- DSL

Wireless Internet Application

CUSTOMER INFORMATION
Are you a current Internet customer of Independent Networks? Yes No           
If "yes", would you like to keep your dial-up account for an additional $19.95.month? Yes No
Are you a current telephone customer of Independent Networks? Yes No
Are you a current Starcom Cable Satellite customer? Yes No
 *Name:
 *Street Address:
 *City:
 *State:      *Zip:
 Billing Name (if different):
 Mailing Address:
 City:
 State:         Zip:
 *Home Phone with Area Code:
 Work Phone with Area Code:
 FAX (With Area Code):
 County:
 Your Social Security Number:             Your Federal Tax ID Number:           *Your Mother's Maiden Name (For Security):
   
Best Time for Installation or to Contact You: 
PRIMARY E-MAIL ADDRESS
 *1st Requested Choice - no punctuation         *2nd Requested Choice
 (Or current NCN e-mail address):                      (if 1st isn't available):
@netins.net      @netins.net
E-Mail Address Note:  Eight characters or less.  If yours is unacceptable or unavailable, one will be chosen for you.
*Denotes Required Fields
WIRELESS PLANS
  256k - $29.95/Month
Plus $65 Installation
Includes 5 e-mail accounts
  512k - $37.95/Month
Plus $65 Installation
Includes 5 e-mail accounts
Great choice for "power" home user or business.

Not all locations can receive Starcom service. There will be a no
charge site survey to make sure service is available in your location.

INSTALLATION INFORMATION
  1. Customer is responsible for expense of mounting apparatus. Where possible, Starcom will use existing customer mount or will install a new mount at customer’s expense.
  2. Installation fee includes up to two hours of labor, coaxial cable, grounding apparatus and coax connections. Does not include burying, if needed.
  3. Starcom’s pricing allows the customer to use the Starcom equipment. The antenna, transceiver and Internet modem are the property of Starcom.
STANDARD INSTALLATION TERMS
Standard Installation includes installation of wireless equipment and connection to one computer. Installations that require extraordinary time or resources will be billed an additional charge of $65 per hour. Customer will be informed of charges prior to installation. Customers requiring connection of two or more computers must contact authorized computer installer. Monthly service charge includes use of Starcom equipment. Ownership is retained by Starcom. Customer agrees to maintain service for one year. Customer agrees to $65 installation fee and other charges if necessary.

ADDITIONAL E-MAIL ADDRESSES
Accounts receive 2 e-mail addresses.  You may request additional addresses for $5.00 each per month.  
 1st Additional E-Mail Address (no punctuation):
@netins.net

 2nd Additional E-Mail Address (no punctuation):
@netins.net

 3rd Additional E-Mail Address (no punctuation):
@netins.net

 4th Additional E-Mail Address (no punctuation):
@netins.net

Note: Eight characters or less.  If your choice is unacceptable or unavailable, one will be chosen for you.

COMPUTER SYSTEM
  MINIMUM REQUIREMENTS: WE RECOMMEND:
Memory
PC CPU
PC OS
Mac CPU
Mac OS
64 MB of RAM
Pentium or AMD K6-2
Windows 98
Power PC
System 8
128 MB or More
Pentium III or AMD K7
Windows 2000 or XP
G3
System 9 or Higher
CUSTOMER SERVICE AGREEMENT
1. These Services are provided by Independent Networks, 523 6th Street, Armstrong, IA 50514 and backbone service through Starcom, PO Box 8, Graettinger, IA 51342.
2. All charges will be billed monthly. Independent Networks reserves the right to increase fees regardless of contract date or package option. Payment is due as specified on the monthly invoice.
Failure to pay when due may result in suspension or discontinuance of service. A service fee will be required to re-establish suspended service.
3. INDEPENDENT NETWORKS MAKES NO EXPRESS OR IMPLIED WARRANTY OF ANY KIND. THERE IS NO EXPRESS OR IMPLIED WARRANTY OF MERCHANTABILITY OR FITNESS FOR
A PARTICULAR PURPOSE FOR THE SERVICES TO BE PROVIDED BY INDEPENDENT NETWORKS. The Independent Networks’ network protocols call for end-to-end verification of the
accurate receipt of any message. Independent Networks makes no attempt to verify accurate receipt of any message and is not responsible for any loss of data resulting from delays, non-deliveries,
incorrect deliveries or service interruptions, including those caused by the negligence, errors oromissions of Independent Networks, nor for consequential damages regardless of their cause.
4. Customer agrees to comply with the terms governing use of the Independent Networks’ network.
5. Independent Networks reserves the right to limit the size of e-mail attachments to 3 MB.
6. This agreement shall be governed by and construed in accordance with the laws of the state of Iowa applicable to contracts to be performed entirely within the state.
7. Either party may terminate service at any time by giving written notice. Such notice is effective when given. Customer is obligated to pay for one-year of service, regardless of their disconnect
date, because contract is for a 12-month period.
8. IT IS EXPRESSLY AGREED AND UNDERSTOOD THAT INDEPENDENT NETWORKS IS NOT RESPONSIBLE FOR THE INFORMATION WHICH MAY BE ACCESSED OR RECEIVED
THROUGH THE INTERNET AND INDEPENDENT NETWORKS DOES NOT WARRANTY THE ACCURACY OR APPROPRIATENESS OF ANY INFORMATION. CUSTOMER AGREES TO
HOLD INDEPENDENT NETWORKS HARMLESS FROM ANY AND ALL CLAIMS WHICH MIGHT ARISE FROM CUSTOMER'S USE OF THE INTERNET.
9. Please Note: No matter how fast your connection to the Internet, speeds on the Internet itself can affect download performance. While DSL users are connected, actual downloads from the Internet
will vary in speed. Factors that govern an Internet download speed include the performance of the server hosting the website requested, the bandwidth of the connection between the website's server
and the Internet, Internet traffic patterns, router latency and backbone usage. FTP file transfers will be received at higher speeds than HTML web pages. Certain times of day tend to have higher
Internet traffic than others. Components in user's PCs may also impose certain speed limitations.
PAYMENT INFORMATION
I accept and understand the Customer Service Agreement and the Standard
Installation Terms. I further acknowledge that I agree to a one-year contract for
service, if service is available to me.

   If you do not agree, click this button to exit without submitting this application: 


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All text and original graphics copyright © 2006 Independent Networks

Independent Networks
523 6th Street, PO Box 379, Armstrong, Iowa 50514
712-868-4040


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