ZIRKEL Wireless: Steamboat Springs Internet Service Access Provider (ISP) | High Speed Wireless Broadband Internet Service Providers (w DSL) Unleash The Internet

Internet Service Order Form

Internet Service Plans
Plan	Monthly Price	Sustained Speed Download / Upload	Speed Burst
Choice	$46.00	1.5 Mbps / 1 Mbps	Up to 8 Mbps download*
Premier	$76.00	3 Mbps / 2 Mbps	Up to 8 Mbps download*
Dedicated Connections up to 50Mbps are available in some areas. Call for a Quote.
Equipment and Installation NOW ONLY $49.00

Prices already include all applicable taxes

* Speed Burst varies by service area. Many factors affect Internet speeds which are not guaranteed.

Customer Information

All fields are required unless noted.

Name:

Company:(Optional)

Phone:

Second Phone:(Optional)

Current E-mail Address:

How did you hear about us?:

Referred by:

Install Location

Physical Address:

City:

State:

Zip Code:

Billing Address*
Same install address
Address:

City:

State:

Zip Code:

*All other billing information will be collected at the time of installation.

Antenna Site (Optional)

If you are familiar with where our antenna sites are located please check which of our antennas have line-of-site to your location. If you are unsure you may skip this section.

Steamboat Springs Area
Celebrity Resorts Hilltop
Bear Claw Condominiums
Colorado Mountain College
Meter Station
Christian Heritage School
Timbers Preserve Water Tower
Mount Werner
Emerald Mountain
Craig Area
Remax Downtown Craig
Sand Rock Water Tank
Cedar Mountain

South Routt
Phippsburg/Greenridge Mountain
Stagecoach
Oak Creek Water Tower
Yampa
North Routt
Clark/Moon Hill
West Routt
Milner
Hayden/COG

Service

Choice Internet Access	$46/month
Premier Internet Access	$76/month

Additional Notes

(Optional)
Please use this space to provide directions to your location, additional contacts, desired installation date or any other important information.

Billing

Payment for the installation and the prorated 1st month is due at the time of installation.

My initial payment method will be:
Visa, Mastercard or American Express
Check - a minimum of three months of prepayment is required at the time of installation
Cash - a minimum of three months of prepayment is required at the time of installation

My preferred billing frequency:
Monthly
Quarterly
Prepay for 6 months and save 10%
Prepay for 12 months and save 15%

My preferred statement method:
Automatic Payment - Charges process on a credit or debit card on the 1st of each month and email receipts are sent.
Email Statement - Statements are emailed on the 25th and payments are due on the 20th of each month.
Paper Statement - Statements are printed and mailed on the 25th and payments are due on the 20th of each month.

Order entered by:

Order Terms

If you cancel service prior to paying for 6 full months there will be an early termination fee of $175. If you relocate service prior to 6 months a $95 relocate charge will apply. At the end of this contract, your service will continue month-to-month, unless you notify us that you would like to suspend or cancel service. The antenna and equipment that we install belongs to ZIRKEL Wireless and it will need to be returned upon cancellation. If you have concerns about antenna placement, please discuss this with the installer before he begins the installation. The complete agreement and company policies can be viewed on our website at the links below.

Internet Service Agreement Acceptable Use Policy

I agree to all of the terms and conditions listed above

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