Nex-Tech Fiber Sign-Up To have fiber brought to your home, please complete this form. Fiber brings ultra-fast internet, crystal-clear television and reliable phone service. Please select the services you are interested in. Your information will be kept confidential. First Name * Last Name * Title of Primary Subscriber Mr. Ms. Mrs. Dr. Jr. Other Primary Phone Number * Secondary Phone Number Email Address * (All correspondence including your service agreement, installation scheduler, and billing information will be sent to this email address.) Date of Birth * Service Address * City * State * Zip * Your Zone Is your billing address different from your service address? Yes, they are different. No, they are not. 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 * Are you currently an existing Nex-Tech customer? * Yes, I'm a current Nex-Tech customer No, I am not a current Nex-Tech customer Are you currently an existing Nex-Tech Wireless Cellular customer? * Yes, I'm a current Nex-Tech Wireless Cellular customer. No, I am not a current Nex-Tech Wireless Cellular customer. Do you rent or own the property where you are looking for service? * Rent Own Landlord Name * Landlord Phone Number * Landlord Email Fiber Offerings Internet * PackageSpeeds Up ToPrice LockA la carte PricingBundled Pricing 300 Mbps + Deluxe TV Now 300 Mbps / 300 Mbps2 year price lock ✔ $169.00 when enrolled in Autopay and Ebill. 100 Mbps + Deluxe TV Now 100 Mbps / 100 Mbps2 year price lock ✔$151.00 when enrolled in Autopay and Ebill. 1 Gig 1000 Mbps / 1000 Mbps$205.00when enrolled in Autopay and Ebill. 500 Mbps 500 Mbps / 500 Mbps $110.00$105.00 when enrolled in Autopay and Ebill. 200 Mbps 200 Mbps / 200 Mbps $90.00$85.00 when enrolled in Autopay and Ebill. 100 Mbps 100 Mbps / 100 Mbps $80.00$75.00 when enrolled in Autopay and Ebill. Internet * PackageSpeeds Up ToPrice LockA la carte PricingBundled Pricing 1 Gig + Deluxe TV Now 1000 Mbps / 1000 Mbps24-month price lock guarantee! ✔ $175.95 when enrolled in Autopay and Ebill. 200 Mbps + Deluxe TV Now 200 Mbps / 200 Mbps24-month price lock guarantee! ✔ $135.95 when enrolled in Autopay and Ebill. 1 Gig 1000 Mbps / 1000 Mbps $104.95$99.95 when enrolled in Autopay and Ebill. 200 Mbps 200 Mbps / 200 Mbps $64.95$59.95 when enrolled in Autopay and Ebill. Internet * PackageSpeeds Up ToPrice LockBundled Pricing 1 Gig + Deluxe TV Now 1000 Mbps / 1000 Mbps24-month price lock guarantee! ✔$175.95 when enrolled in Autopay and Ebill. 200 Mbps + Deluxe TV Now 200 Mbps / 200 Mbps24-month price lock guarantee! ✔$135.95 when enrolled in Autopay and Ebill. 1 Gig 1000 Mbps / 1000 Mbps $99.95 when enrolled in Autopay and Ebill. 200 Mbps 200 Mbps / 200 Mbps $59.95 when enrolled in Autopay and Ebill. Protection Plus Maintenance Plan. Learn More * $9.99/mo. *24-month price lock guarantee. Pre-construction Special (only available to people that sign up before we begin the construction). *Price valid with enrollment in Autopay and Ebill. Without enrollment, monthly price increases by $5. Price reflects current published rates. Rates are subject to change. Subscription to Protection Plus required at $9.99 a month and includes wireless router. Protection Plus includes premiere home Wi-Fi connectivity, wiring maintenance and equipment replacement. Premium Wi-Fi Access Points - Extend your Wi-Fi coverage. Learn More 1 access point - $6.00/mo 2 access points - $12.00/mo TV Offerings - Internet Required * PackageChannel LineupPricing TV Now Standard Click for details $30.00/mo TV Now Deluxe $76.00/mo Not Interested Basic charges do not include federal, state and local taxes and mandated charges. TV Now Additional Features - All TV Now plans include 3 streams and 50 Hours DVR storage. 1 additional stream + 50 Hrs. DVR - $5/mo 2 additional streams + 100 Hrs DVR - $10/mo Premium TV Now Packages Cinemax - $11.95/mo Showtime & TMC - $14.95/mo HBO - $17.95/year Starz/Encore - $12.95/mo Sports & Entertainment - $13.95/mo NFL Redzone - $49.95/year Voice Offerings Local Phone Service Options * PackageIncludesMonthly Price Local Phone Service $18.50/month Frequent Caller 200 Local phone service, 200 minutes of long distance, Caller ID Name and Number$37.05/month No Limits Local phone service, Caller ID Name and Number, Call Waiting, Call Waiting ID, Three-way Calling, unlimited long distance calling within the continental U.S.$45.00/month Not Interested Basic charges do not include federal, state and local taxes and mandated charges. Local Phone Service Options Local Phone Service - $18.50/month Frequent Caller 200 - $37.05/month Includes: Local phone sevice, 200 minutes of long distance, Caller ID Name and Number No Limits - $45.00/month Includes: Local phone service, Caller ID Name and Number, Call Waiting, Call Wating ID, Three-way Calling, unlimited long distance calling within the continental U.S. Basic charges do not include federal, state and local taxes and mandated charges. Long Distance Service One low rate of 8.9¢ per minute, anytime, anywhere in the continental U.S. No monthly fees or hidden costs. No monthly minimum. No dial-around codes. Calling Features Caller ID Name/Number* - $9.45/month Non-listed number - $3.50/month Call Forwarding - $3.00/month Non-published number - $4.90 Call Waiting - $7.65/month Three-Way Calling - $1.00 Call Waiting ID - $2.50/month Voicemail - $3.95/month (Includes Voicemail-to-email) Distinctive Ring - $3.00/month Extra calling features available upon request. *Includes Anonymous Call Rejection. Would you like to keep your current home phone number? * Yes No Number of phone lines that need service * 1 Phone Line 2 Phone Lines Who is your current Phone Provider? * Current Phone Number * Current Phone Number Line 2 Bill Payment & Additional Options How would like to pay your $25.00 Pre-Registration Payment? * PayPal (Credit/Debit) Your per-registration payment will be applied to your first bill after services are installed or refunded if fiber is not built to your zone. Bill Pay Options * Your monthly statement will be sent via email to the email address provided above. How did you hear about Nex-Tech Fiber? * Email Community Event Direct Mail Facebook Fiber Champion Employee Service Truck Referred by a friend/neighbor Web Advertisement Web Search Other Other Description Fiber Champion * Preferred Household Language? * English Spanish To assist our construction crew, please list any fences or buried facilities (geothermal lines, sprinkler system, etc.) on your property that would not be found during a locate. Any comments or additional information that we should be aware of? reCAPTCHA Submit
