TCC High-Speed Internet Online Application

Internet services provided by Tri-West Communications, LLC
A TCC Company
Providing tomorrow's technology today.

High-Speed Internet Application

Please complete all of the items below. If an item does not apply to you, please fill in "N/A" for "not applicable". If you have a question, please contact us before proceeding.

Personal Info
Name
Company/Organization
Install Address
City, State, Zip
Billing Address (if different)
City, State, Zip
Home/Main Phone
Other Contact Phone
E-mail Address
Contact Preference	Home Phone Other Phone E-mail
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Packages
Plan	Speed	Email Address(es)	Price
Pro-Surfer	3 MB	6	$59.40 per month ($53.45 with discount*)
Super-Surfer	2 MB	5	$51.40 per month ($45.45 with discount*)
Surfer	1 MB	3	$43.40 per month ($37.45 with discount*)
Lite-Surfer	256K	1	$35.40 per month ($29.45 with discount*)
Business Level			Service - quoted
Please choose which service level you would like:
We offer a $5.95/month discount on our high-speed services for those who also subscribe to our cable tv or telephone service. Both services must be under the same name/membership.*
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Installation & Computer Info
Installation is $25.00 and includes professional installation of line, jack and modem to one device.
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Your Operating System:
.
Which plug-in device do you have on your computer?
*Please note: USB may not work at all if your computer has Windows 95 or Windows 98.
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High-Speed Modem

Basic: High-speed modem with 1 ethernet port or 1 usb port for connecting to 1 device.
Lease for $2.49/month I am interested in purchasing a modem

Wireless Combo: High-speed modem with 1 ethernet port and a wireless router in one.
Lease for $4.49/month I am interested in purchasing a modem

You will provide your own modem
Customer will own and maintain equipment.
Call us to make sure your modem is compliant with our equipment.

Routers

A router is a device connected between the modem and the computer(s) for providing security and for sharing a single connection with multiple pc's in a home or office setting. A router is not required, but they are welcomed on our network. You can setup your own or have us help you.

Please choose from the list:

Do You Already Have A Dial-Up Account With Us?

Please let us know if you would like to keep your dial-up account upon sign-up or installation of Cable/DSL Internet. Dial-up access is not included with Cable/DSL; additional package charges do apply.

Yes

Terminate my dial-up access when high-speed is installed
Keep dial-up access; I will pay for both accounts

SecureIT+ Virus & Security Protection

Virus detection & removal	Firewall protection	Pop-Up Blocking
Spyware detection & removal	24-7 Help Desk	Windows Updates
Automatic updates & scanning	Remote Assistance	Hard drive optimization
Professional installation	Guaranteed protection	Monthly protection reporting
Just $7.95/month per computer No setup or installation fees
Yes, sign me up for SecureIT+ with protection for computer(s)

Adult Content Blocking

Protect your family from inappropriate content online. Filter Levels | Print form for later

Yes, sign me up for Adult Content Blocking! Set level

You can only remove or lower Adult Content Blocking in writing with a sign-up Form.

Username/E-mail Addresses

You will need a main login/username to login to our internet. If you are already a customer, you can use your current username/e-mail address or choose a new one. If you use your current username, you will need your password.

I already have a username and would like to keep using it.
        My current username is:
        I have my password
        Please reset my password   *Passwords are reset the day before your scheduled install.

I do not have a username or would like a new one.
I want my login to be: 1^st choice 2^nd choice

I would like the following additional e-mail addresses:

Addresses can be 3-16 letters/numbers long; please no spaces or punctuation.

Questions or Concerns?

If you have questions or concerns, please include them below:

We will contact you in 3 to 7 business days to set up an installation appointment.
The installation fee and pro-rated first month of service will be billed to you.

Please Read Our Acceptable Use Policy

Name of person filling out this application

I am 18 years or older, I am the responsible person for this account
and I have read and agree to the Acceptable Use Policy

Thank you for signing up for High-Speed Internet!