Internet Service Application

Sherwood Mutual Telephone Association [SMTA]
An Equal Opportunity Employer and Service Provider

Billing Name *

First

Last

Street Address *

Phone *

Check All Options That Apply *

I will be using internet for Business purposes
I willl provide my own wirless router
I want to purchase a $100. router for Dual Band
I want to purchase a $160. router for Tri Band

Select A Download Speed (choose one) *

*cost of phone service in not included in price shown.

Username *

Please choose a username that is at least 6 alpha or numerical characters and no more than 15. This username will be used as your e-mail address (username@smta.cc)

Password of your choice *

Password requires minimum of 8 characters to include (2) numbers (1) special character and (1) capital letter.

Signature *

I acknowledge that I have read The Sherwood Mutual Telephone Association Customer Agreement and accept all terms and conditions. I also understand that use of my Sherwood Mutual Telephone Association Broadband service may be subject to sales tax. Subscribers are billed on a monthly basis on the same bill with their regular local telephone service. (Entering your full name in this field will be considered a valid signature for this contractual agreement.)

*New INTERNET Customers Only

I agree to subscribe to the INTERNET service for twelve (12) months, and understand I will be billed a $200.00 early termination fee if Internet is disconnected before twelve (12) months. (Entering your full name in this field will be considered a valid signature for this contractual agreement.)

Date *

please use MM/DD/YYYY format

Name

Broadband Internet Service Application