Order Service 1 Service Type2 Contact Information3 User Information4 Service Selections5 Agreements Select Service Type(Required)Please Select...ResidentialCommercialCheck Service Availability Get Notified When Fiber Service is Available to Your Address We are constantly expanding, get on our list so we can notify you when AireBeam Fiber becomes available. Name(Required) First Last Company Name(Required) Company Billing Contact(Required) First Last Service Address(Required) Street Address Apt/Suite Number (if applicable) City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Type(Required)Please Select...RVSFR 1 StorySFR 2 StoryMobile HomeOtherPhone(Required)Email(Required) Billing Email Homeowner/Renter?(Required)Please Select...HomeownerRenterProperty Ownership(Required)Please Select...Own BuildingLeasing Space/BuildingPlease provide Landlord contact information.Name/Property Management Owner Email/Phone Number How did you hear about us?(Required)Please Select...Search Engine - Google/MSN/Facebook/InstagramDoor Hanger/PostcardCustomer ReferralEmployee ReferralACP Program ReferralSchool FundraiserBillboardOtherCustomer Name(Required) Customer Phone Employee Name(Required) First Last Name of School(Required) Please complete...(Required) Customer PIN(Required)Please select a 4-6 digit code so we can identify you when you call in. Company PIN(Required)Please select a 4-6 digit code so we can identify you when you call in. Authorized User(s)Please enter first and last name. Authorized User PhonePlease enter your Authorized User's phone number. Select Location(Required)Please Select...Other Location, Not Listed.Arizona CityArlingtonBuckeyeButtes at Sundance 2Casa GrandeCoolidgeDesert Gardens RVEloyFairways Mobile Home ParkFlorenceGila BendGoodyearHidden ValleyMaricopaPalo VerdePicachoPicacho Peak RVPicacho Peak State ParkQuail Run RVRoad Runner Mobile Home EstatesSan LucySan Tan ValleySilverbellStanfieldSundance RV 1Sundance RV 2 & 3The Buttes at SundanceTierra Del SolTonopahValley FarmsOther Location, Not Listed.Residential Broadband PlanPlease Select...10M/5M - $44.9520M/10M - $59.9530M/15M - $69.9540M/20M - $79.9550M/25M - $89.95*Approval required for speeds over 20MBResidential Broadband PlanPlease Select...50M/10M - $40.00*Approval required for speeds over 20MBResidential Fiber PlanPlease Select...RES Fiber 1G - $90.00RES Fiber 750mbps - $75.00RES Fiber 500mbps - $55.00*Approval required for speeds over 20MBSelect Term(Required)Please Select...1 Year ContractMonth-to-MonthRouter Selection(Required)Please Select...Monthly Rental - $10/mthDecline RouterSmall Business Broadband PlanPlease Select...10M/5M - $89.9520M/10M - $119.9530M/15M - $159.9540M/20M - $179.9550M/25M - $239.9580M/40M - $399.95100M/50M - $499.95*Approval required for speeds over 20MBSmall Business Fiber PlanPlease Select...SMB Fiber 1G - $180.00 mo.SMB Fiber 750mbps - $150.00 mo.SMB Fiber 500mbps - $100.00 mo.*Approval required for speeds over 20MBSelect Term(Required)Please Select...2 Year ContractMonth-to-MonthRouter Selection(Required)Please Select...Monthly Rental - $15/mthDecline Router Please review the agreement(s) and/or disclosure(s) for your order and sign below. A copy of this completed document will be emailed to you upon submission of this form.Signature(Required)CommentsThis field is for validation purposes and should be left unchanged.
