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RESIDENTIAL WIRELESS BROADBAND APPLICATION FORM

NOTE: An Installer will call to set up an installation time with an applicant within two weeks of SIS Systems receiving the ISP application.

* Required

PERSONAL INFO:

* First Name:	* Last Name:
Company (if applicable):
* Address:	* City:
* Postal Code:	Work Phone:
* Home Phone:	Cell Phone:

Additional Comments:

RESERVE INFO: (for First Nation residents ONLY)

* Reserve Name:	* Reserve Community:
Treaty # / Exemption: (Required or GST will be charged)

SUBSCRIPTION PLAN:

I 100 (Residential)
Installation Fee*: $250.00
Charge: $65.00/month
Up to 1.5 Mbps for downloads / up to 700 Kbps for uploads
3 email accounts (7 MB) each
10 GB/month downloading, 2 GB/month uploading
Non-Static IP address

Email:

Would you like to use your current email address or setup a new
@sis.net email address?
Use my current email
Setup a new @sis.net email address

Please provide your preference below:
Note: Contact the office for your temporary password. (1-877-701-4050)
* @sis.net

@sis.net

@sis.net

Current Email Address:
*

Monthly Statements:

How would you like your monthly statements sent to you?
Via Email
Mailed to my residence ($2.75 FEE)

NOTE: An Administration Fee of $2.75 will be charged to your account on a monthly basis if you choose to have your invoices/statements mailed to your mailing address. There is no charge for email.

ADDITIONAL HARDWARE REQUEST/OPTIONS:

Please check off the boxes for additional hardware and or software and your SIS SYSTEMS Technician will install and configure the following you have chosen upon installation.

		Network Router / Firewall ( HIGHLY RECOMMENDED ) -- $109.00* Protects your computer, data, resources and network from internet attack and unwanted traffic which will harm and slow down your computer and network.
		Antivirus Software with One Year Subscription -- $59.00* Works in protecting and blocking your computer from viruses via email, Internet browsing and general use which harm and slow down your computer and network.
		Antispyware Software with One Year Subscription -- $49.00* Protects your computer and network from harmful spyware programs which slow down your computer and internet.

EQUIPMENT OWNERSHIP:

The Customer agrees that all equipment will remain the property of SIS SYSTEMS unless agreed otherwise. The Customer agrees not to sell, transfer, lease, or assign any interest in or mortgage or encumber all or any part of the equipment provided by the Company. The Customer agrees to pay SIS SYSTEMS the full cost of repair and/or replacement if damage occurs that is not the fault of SIS SYSTEMS.

Please check the below box and type in your full name if you agree with the ownership terms.

I AGREE TO THE ABOVE TERMS

* Full Name:

AUTHORIZATION:

I hereby authorize and request the installation of High Speed Internet Service at the above address. I understand and agree to the following:

I have read, understand and agree to the High Speed Internet terms of service contained as part of this form.
I will receive all SIS Systems by email at the end of each month, to the SIS Systems email account I was provided at the time of install.
I agree to pay the monthly fee for this service as listed on this form. If I fail to pay this fee my High Speed Internet service will be disabled until payment is received
A subscriber unit will be provided by the installer. The provided subscriber unit is owned by SIS Systems. If you cancel your internet service SIS SYSTEMS will remove the subscriber unit.
I will be contacted by SIS Systems to arrange installation. Installer will call within TWO WEEKS of application submission.
SIS Systems will cooperate with law enforcement if a criminal violation is suspected