DATE: ________________        BILLING NUMBER: 503.845. _______     BROADBAND NUMBER: 503.845. _______
NAME: ___________________________________________________________________________________________
SERVICE ADDRESS: _______________________________________________________________________________
BILLING ADDRESS: _______________________________________________________________________________
Please check the applicable BROADBAND INTERNET Service:

BROADBAND SERVICE, INCLUDES INTERNET

SpeedChoice Bundle - Residential
Includes 3.0M high speed internet, local access line, Call Waiting, Call Forwarding, Three Way Calling, and Caller ID
$ 44.95 mo.
XtremeSpeed Bundle - Residential
Includes 6.0M high speed internet, unlimited e-mail accounts, local access line, Call Waiting, Call Forwarding, Three Way Calling, Caller ID and Voice Mail.
$ 54.95 mo.
XtremeSpeed Plus Bundle - Residential
Includes10.0M high speed internet, unlimited e-mail accounts, local access line, and Ten Calling Features.
$ 64.95 mo.
 
Gold - ADSL 3.0 Mbps down/1Mbps up
$ 39.95 mo.
Diamond - ADSL 6.0 Mbps down/1Mbps up
$ 49.95 mo.
Diamond Plus - ADSL 10 Mbps down/1Mbps up
$ 59.95 mo.
Static IP Address (SEE QUESTION 6, BELOW)
$  8.00 mo.
Non-Recurring Charge (New mtangel.net customers only)
$ 15.00
Customer Request Charge
$ 10.00
Modem with one in-line filter (Regular price $64.95)
Free
Wireless Modem/Router. see bottom page
$ 69.00
In-line filters, price each
$ 3.90
Activation fee is $99.00. Activation fee is waived when customer commits to retain service for a minimum 12 month period. If service is disconnected for any reason during the 12 month commitment period, the installation charge will apply.
I understand and agree to the Terms and Conditions of the BROADBAND INTERNET Service Agreement.
__________________________________________________________________________________________________
Authorized Signature            Date
PLEASE ANSWER THE FOLLOWING QUESTIONS:

1) DSL service for a desktop computer comes with a free modem.

2) How many telephones do you have on that line? ____

3) Do you have any wall phone jacks? ____ Yes ____ No   How Many? ____

4) Does your computer have a NIC card? (Network Interface Card) ____ Yes ____ No

5) How many computers will you be hooking up to DSL? ____ For multiple computers, the wireless modem/router can be used with up to four (4) wired computers and more than one hundred (100) multiple wireless connections. The wireless modem/router includes a one year warranty and can be purchased for $69.99...

6) If you require wireless service will you be purchasing a wireless modem/router from Mt. Angel Telephone? ___Yes ___No

7) Do you have a telephone jack with dial tone at the location the DSL modem will be set? ____ Yes ____ No

8) For Static IP Address, what is the MAC Address of the equipment that will have the Static IP on it?

______________________________________________________________________________
XtremeSpeed Plus Bundle - Includes ten (10) Calling Features:
____ Anonymous Call Rejection *77 Prevents telephone numbers with the Line Block features from ringing your telephone.
____ Call Blocking *67 Prevents your telephone number from being displayed on Caller ID.
____ Call Forwarding *72 Allows your phone to transfer incoming calls to another number.
____ Caller ID Allows you to see incoming number and/or name of the caller.
____ Call Rejection *60 Allows you to reject calls from specific numbers so you are not bothered with unwanted calls.
____ Cancel Call Waiting *70 Allows you to deactivate the Call Waiting feature to avoid interruption during a call.
____ Call Waiting Alerts you of an incoming call while you are on the phone.
____ Selective Call Forwarding *63 Allows you to create a select list of number that will ring to a forwarded number.
____ Three Way Calling Enables you to turn a two-way telephone call into a three-way conversation.
____ Voice Mail Never miss an important call! Voice Mail answers the phone, plays a personalized greeting and records the caller's message. All messages are time and date stamped.

See pages 25 - 29 of North Willamette Valley directory for description of services.

Rev: 9/01/09