Home 5 Mi-Fiber Sign Up Form Mi-Fiber Sign Up Form Mi-Fiber Sign-Up Fiber and Voice First Name * Last Name * Date of Birth * Address * City * State * Zip * Do you rent or own the property? * Own Rent Property Owner Name * Property Owner's Phone Number * Dwelling type? * Single Family Home Townhome Condo Apartment Mobile Home Is your home newly constructed? * My home is a new construction My home is a previously existing building Do you currently occupy the home? * Yes No When is the closing date of your home * Who is building your home? * What year was your home built? * 2015 or after 2014 or prior I don't know Are you a member of an HOA? * Yes No HOA Name and Phone Number * Is your billing address different than your service address? * Yes No Billing Street Address * Billing City * Billing State * AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Billing Zip * Email * All correspondence including your service agreement and billing information will be sent to this email address. Primary Phone Number * Secondary Phone Number Internet Service Agreement Term * No Contract – Includes $250 installation fee and no minimum term Twelve Month Contract – Includes free installation ($250 value), one month Service free and minimum twelve month term Please select your Service Package * PackageDownload and Upload Speeds Up ToMonthly Rate Mi-Fiber 100 100 Mbps$59.95 Mi-Fiber 200 200 Mbps$69.95 Mi-Fiber 500 500 Mbps$79.95 Mi-Fiber 1 Gig 1 Gig$99.95 Select Your Router Option * Mi-Fiber Router Equipment Fee $9.95/month. Includes: 24/7 Technical Support Line, full maintenance of router, one Wi-Fi access point and equipment needed to provide the service. Customer Owned Router Equipment Fee $4.95/month. Includes: 24/7 Technical Support Line and equipment needed to provide the service. Mi-Fiber Router Add-Ons * Add Tech Home Protect for $4.95/month (Learn More) Add Tech Home Protect Plus for $9.95/month (Learn More) Add Managed Wi-Fi Service for only $10 more per month (Learn More)Total of $19.95/month includes Equipment Fee and Tech Home Protect, in addition to Managed Wi-Fi Service. Add Tech Home Support for only $15 more per month (Learn More) Total of $24.95/month includes Equipment Fee and Managed Wi-Fi Service in addition to Tech Home Support features. Additional access points are available for $7.50/month/device. No thank you Customer Owned Router Add-Ons * Add Tech Home Protect for $4.95/month (Learn More) Add Tech Home Protect Plus for $9.95/month (Learn More) No thank you All advertised speeds may not be available in all locations. Call for more information. *One year Service Agreement required. We will email the Service Agreement for your electronic signature before you schedule your installation. Additional IP Address * No Thank You 1 Usable IP Address - $16.00/month 5 Usable IP Addresses - $32.00/month (required for any Customer-owned equipment that needs a public IP address - contact Mi-Fiber to discuss or if more IPs are needed) Voice Service Mi-Fiber is happy to offer Aureon Voice Service for $20.00 per line/month! * Yes, I'm interested in Aureon Voice Service! Not at this time. Installation Details: A non-recurring installation fee of $100 will apply. Standard installation includes one phone/Analog Telephone Adapter (ATA) at the router. Installation of any other phones or equipment during initial installation will be billed at time and material. How many phone lines do you need? 1 2 3 4 5 Are you interested in purchasing a phone/phones from Mi-Fiber to use with your Aureon Voice Service? * Yes, please contact me with current pricing No thank you Long distance charges are billed at $.06 per minute. Additional charges apply for directory assistance and operator assisted calls. * Yes, I agree to the long distance charges listed above. In addition to Mi-Fiber Aureon Voice Service, Mi-Fiber also offers fax lines. * Yes, I'm interested in a Mi-Fiber Aureon Traditional Fax Line for $25.00/month Yes, I'm interested in fax to Email service for $7.99/month No thank you How many traditional fax lines do you need? 1 2 3 4 5 How many fax to email services do you need? 1 2 3 4 5 Equipment Purchase (required) * ATA - Cisco Small Business VoIP AdapterCurrent pricing will be provided to Customer upon request Maintenance Service Agreement The minimum term for ATA Maintenance service agreement is 1 year, beginning on the Service Installation date. ATA Maintenance Service Agreement $3.00/month No Thank You. NOTE! Fiber optic services and Voice over IP (VoIP) require backup power to continue functioning during a power outage. To minimize disruption of Service during an outage, Mi-Fiber offers the following uninterruptible power supplies (UPS) with limited battery backup capability. Uninterruptible Power Supply (Optional)Current pricing will be provided to Customer upon request Please let us know how many UPS units you require. Bill Pay Options & Additional Information Bill Pay Options * Email Bill Notice and Auto Pay via Checking Account Email Bill Notice and Auto Pay via Credit or Debit Card Email Bill Notice and Mail Payment How did you hear about Mi-Fiber? * Please select an option Website Email Direct Mail Billboard Yard Sign Vehicle Decal Radio Advertisement TV News Story Waukee Living Dallas County Today A Friend Twitter Facebook Public Event Realtor TV Commercial Spotify Church Other How did you hear about Mi-Fiber? Brokerage/Realtor * Let us know who told you about us. * Mi-Fiber yard signs are a great way to increase interest in your area. Would you like to have a sign placed in your yard? * Yes, please put a sign in my yard No, thanks Please write in anything that our construction crews need to be aware of in your yard. (dog fence, sprinkler system, etc.). Terms and Conditions * I agree to Mi-Fiber's Terms and Conditions If you are human, leave this field blank. Submit
