Secure Residential Order Form

Personal Information

Name *

First

Last

Email *

Phone *

Service Address *

Street Address

Unit / Apartment / Suite

City

Province

Code Postal

Billing Address Selected

Send Invoices to a Different Address

Select Your Services

Residential Naked ADSL Internet Plan *

Monthly rates indicated for the various plans do not include applicable taxes, monthly tariff/dryloop fee ($6.95 to $26.95 depending on location ), a one time $39.95 Dryloop Activation Fee and a one time Set-up Fee of $49.95. All prices as well as other aspects of our services are subject to change without notice.

Home Phone *

Requested Install Date

Install Date Selection *

If a Technician visit is required I would prefer:

ADSL / VDSL Modems

ADSL Modems *

Ovislink OV804 WVA - WIRELESS - modem - $129.95
Ovislink OV604 WVA - BONDED WIRELESS - modem - $139.95
I will use my own compatible cable modem

Routers

Vilo Mesh Routers

Vilo Mesh Router (purchase one unit) - $49.95 (coverage up to 1000 sq. ft.)
Vilo Mesh Router (purchase three units) - $139.95 (coverage up to 3000 sq. ft.)
Rent a Vilo Mesh Router (monthly per unit) - $3.00

Payment Information

Payment Options *

Pay by Credit Card
Pay through my Bank Account
Pay by Cheque
Pay by Cash in Person

Referral Code

Authorization

Authorization *

I agree to the terms and conditions *

Please note once a representative has received your online order we will perform a search to verify we can deliver cable internet service to your address. Next using the contact information provided a Lightspeed CSR will call to verify a convenient install date along with your billing information. There will be no charges if we cannot provide service to your address. Cable Internet Speeds posted are maximum speeds provided and can fluctuate.

I acknowledge that this is a prepaid service. The first month and hardware sales will be charged today. All monthly fees are payable on or before the 1st of each service month.

Once an order has been confirmed, it can only be cancelled within 24 hours. Once provisioning and activation is complete the account becomes active immediately and billing commences immediately. Due to technical reasons this cannot be delayed.

All prices as well as other aspects of our services are subject to change without notice.

To show your acceptance of and willingness to be bound by the terms and conditions listed on our website, please add you signature in the provided panel, then tick the box "I AGREE" above and click Submit at the bottom of this form. Click here to view our complete Terms and Conditions.

Prices indicated for the various plans (with the exception of monthly specials) do not include one month deposit, applicable taxes, tariffs, $15.00 set-up fee or the $4.95 per month network access fee. All prices as well as other aspects of our services are subject to change without notice.

Signature *

(use your finger, stylus, or mouse to sign in this space)

RESIDENTIAL ORDER FORM

ENTER YOUR INFORMATION WITH CONFIDENCE – THIS IS A SECURE SERVER!