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
. .
 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.
.
 Installation & Computer Info
    Installation is $25.00 and includes professional installation of line, jack and modem to one device.
.

  Your Operating System:  

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  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.
.
 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.
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 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:    
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 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
        No
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 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.
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 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: 
1st choice     2nd choice
  I would like the following additional e-mail addresses:

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

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

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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

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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

               

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Thank you for signing up for High-Speed Internet!


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

info@tcc.coop | Back to TCC Home Page | High-Speed Services