Sign Up / Service Order Form | Procom

Customer Name (Exact Legal Name) *

Location Type

Tax Exempt We will need a copy of the Exemption Certificate.

Billing Address *

Physical Address (if different)

Contact Name *

Contact Telephone No. *

Email Address *

Fax No.

State Id No.

Please enter the main billing telephone number. This is the main number of the location that additional lines, if any, will be billed to. If you need a second billing telephone number, please enter it in the provided box.

Main Billing Telephone # *

Additional Billing Telephone #

No Package – Select Individual Services Below Option 1: Local Phone Service, Unlimited Long Distance*, Lifeline Basic Cable Service***, and Express Internet 30Mb/30Mb ($125.00) Option 2: Local Phone Service, Unlimited Long Distance*, Premier Digital Cable Service**, and Advanced Internet 50Mb/50Mb ($145.00/month) Option 3: Local Phone Service, Unlimited Long Distance*, Premier Digital Cable Service**, 18 Starz and Encore channels, and Expert Internet 100Mb/100Mb ($160.00) Option 4: Local Phone Service, Unlimited Long Distance*, Premier Digital Cable Service**, 33 Starz, Encore, HBO, Showtime, and Cinemax channels, and Platinum Internet 200Mb/200Mb ($185.00)

ADD Wireless Router to any package $5.95

Broadcast ID

Password

Add Additional HD Boxes ($10 Each)

Number of Additional HD Boxes

* Unlimited Long Distance – Continental US Only

** 180 Digital Channels for one room & 56 Lifeline Basic Channels in additional rooms with Digital TVs. Upgrade additional rooms from 56 Lifeline Basic Channels to 180 Digital Channels @ $10.00/Month/Room for HD Service (Lifeline HD Channels require an HDTV. National HD Channels require an HDTV & HD Receiver). Please note that Analog TVs without a Receiver will only receive 25 of the 56 Lifeline Basic Channels. Upgrade Analog TVs from 25 Basic Channels to 56 Channels @ $10.00/Month/Room.

*** 56 Lifeline Basic Channels on all Digital TVs. Analog TVs without a Receiver will only receive 25 of the 56 Lifeline Basic Channels. Upgrade Analog TVs from 25 Basic Channels to 56 Channels @ $10.00/Month/Room. Lifeline HD Channels require a HDTV.

Cable

None Lifeline Basic Cable TV (56 Channels) $42.99 Premier Digital Cable TV (180 Channels) $86.00 Super Saver Cable TV (192 Channels) $98.00 Gold Cable TV (222 Channels) $136.00

Internet

None

Express 30Mb/30Mb $55.00

Advanced 50Mb/50Mb $65.00

Expert 100Mb/100Mb $95.00

Platinum 200Mb/200Mb $145.00

Diamond 500Mb/500Mb $250.00

Wireless Router $5.95 Static IP $25.00

Open Internet Disclosure: ProDigi/Mountain Communication dba ProCom/Digital Connections does not practice blocking, throttling, affiliated prioritization, or paid prioritization. In addition, the above mentioned companies offer unlimited data with no caps whatsoever.

Phone Service

Local Telephone Service with Three Free Calling Features (Not available in all areas) $30.00 Long Distance Telephone Service .049 cents/min

Month to Month Or Individual Services: $75.00 2 Year: $0.00. All activation fees waived.

If Service is terminated pursuant to Sections 2.12.1 or 2.12.2 of the Company’s Terms And Conditions or if the Customer requests cancellation of Service after installation but prior to expiration of a minimum Service commitment period, Customer agrees to pay the Company the full amount of any waived installation charges, which shall be due and payable as of the effective date of cancellation or termination.

Email Billing Paper / Mail – $4.95 Monthly Fee

To help us prevent spam, what is 4 + 6?

By submitting I certify that I am at least eighteen years of age and that I have read and understand the terms and conditions of this letter of agency. I also certify that I am authorized to change or establish the services indicated above for this location. I am further authorizing Procom to do a credit check investigation and hold free from liability all creditors and other persons who may respond to “inquiries”.