| Customer Profile Information: |
Please fill in the following section with your permanent residence mailing and contact information.
* Indicates a mandatory field
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| * Customer Name: |
Company Name: |
* Phone: |
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| Fax: |
* Mailing Address: |
Suite/Apt: |
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* City:
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* Province: |
* Postal Code: |
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| * Daytime Phone #: |
Ext: |
* Email Address: |
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| Site Service Information: |
| * Physical Street Address: |
Suite/Apt: |
* City: |
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| * Province: |
* Postal Code: |
* On Site Contact(s): |
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| * On Site Phone |
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Do you own the property at the Service Location or rent?
Rent
Own |
| If Renting, Your Landlords Name and Phone is mandatory |
| Landlords Name: |
Landlords Phone: |
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| Note: You will need your Landlord’s written permission to install the wireless equipment on the building prior to service being installed. |
| Service Plans |
Residential Wireless
- $49.95/mth including hardware rental and hardware replacement coverage
- 1 year contract
- One Time standard installation charge of $149.95
- Up to 1.5 Mbps downstream, Up to 512 Kbps upstream
- No data transfer cap at this time
- 5 Email accounts
- No Charge Dialup connection if High Speed Connection fails
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| Payment Information: |
I understand that an automatic payment method is required. I will provide Vianet with
A Void cheque for automatic bank withdrawals
My credit card number for automatic billing
Note: Automatic payments may be set for the 10th or 21st day of the month
I understand that at the time of booking an installation a payment equivalent to one month’s Wireless service, plus hardware charges is due to Vianet. If this initial payment is not made prior to installation I understand that my installation date may be moved until this payment has been received. This initial payment is not a deposit, but will pay for my first month of Internet service and hardware rental charges.
I understand that there is a $10.00 NSF charge for all returned cheques
I understand that if payment is not made by the 21st of the month my service may be locked until payment is received. |
| Conditions of Service: |
This order form constitutes an order of service ("Order") by Vianet Internet Solutions. By signing the order form, you confirm the information you have provided to Vianet Internet Solutions is true to the best of your knowledge and that you are 18 years of age or older. The installation includes running an outdoor CAT 5 cable from radio equipment mounted on the outside of the building to a point of demarcation inside the building. Any internal CAT 5 runs from the point of demarcation to computer equipment will be the responsibility of the client. Install price based on a Standard Install. Additional install charges may apply if install is Non-Standard. Additional charges will be quoted prior to implementation of equipment. The external radio equipment will remain the property of Vianet and shall be returned to Vianet upon cancellation or suspension of service. Client will be billed $500 should the external radio equipment not be returned. Minimum residential reconnect fee of $75.00.
Cancellation Policy: Cancellations are processed at the end of each month. Vianet requires a minimum of 10 days notice for cancellation of all residential services. Services on contract may require 30 days notice, so review your contract for the cancellation policy. Please be advised that all rental equipment, including power supplies, cables and filters, must be returned within 5 days of the cancellation date in full working condition and free of damage. Rental equipment should be shipped to, or dropped off at any Vianet office. Please contact us at 1-800-788-0363 ext. 7208 for more information about return shipping of rental equipment. Charges for unreturned or damaged equipment will be applied to accounts within the next billing cycle.
You agree to pay in full the monthly price of your service as well as a one-time installation fee of $149.95 plus applicable taxes. You agree to be bound to the billing policies as stated on www.vianet.ca |
I agree to be bound to this contract and wish to submit my form for enrolment.
I do not agree to bound to this contract and do not wish to submit my form for enrolment
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| Additional Notes |
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