Service Request Form

Fill out the form below to order Nedernet Internet service. Coverage is limited to line-of-sight (or near line of sight) to one of our antennas.

You should hear back from us within 24 hours of submitting this request. Payment of the setup fee (if applicable) is required at time of installation. A 1-year contract is required for free installation. Billing will be done on a monthly, quarterly or yearly basis (yearly payments will recieve a 10% discount). Cash, check and major credit cards are accepted.

Name:
(first)
(last)

Billing Address:
City: State: Zip:

Physical Address:

Email Address:

Home Phone:

Service Desired:
Economy ($29.99/month)
Residential ($50/month)
Home office ($75/month)
Commercial ($89.99/month)


Add unlimited transfer ($35/month)


Will you require a wifi router?
(A wireless router is necessary for home wifi and can be purchased through Nedernet for $40.)
Yes
No

Desired service state date:


One-year contract/free install?

Special Instructions:


Payment Method:

Bill Me
Credit Card:


(this is a secure form)
Name on Card:
Card Number:
Exp. Date (mm/yy):


I have read and agree to the Acceptable Use Policy.

Please enter the characters you see in the box below:



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