_________________________ (Customer) desires to purchase high-speed data service for the following residential/business location:______________________________________________
and customer agrees to purchase said service on the following terms:
1. Service Plan selected: ____________________
2. Commencement date and period of service: The set up fee of $29.95 will be waived upon installation of High Speed Data service if customer agrees to continue service for a minimum of twelve (12) months. After expiration of the minimum period, customer may cancel service at any time on thirty (30) days notice to FTC. If, for any reason, customer cancels service prior to the expiration of the minimum period or if service is terminated by FTC prior to the expiration of the minimum period as a result of customer’s breach of the obligations set forth herein, then, the customer will be obligated to pay the monthly charge for service for the balance of said minimum period.
3. Use of Equipment: FTC will install & provide the use of a high speed data modem at the service address stated above, whether internal or external. This equipment will remain the property of Federated and will be returned by customer to FTC immediately upon termination of service for any reason in good repair, reasonable wear excepted. If the equipment is not returned upon termination of service, customer agrees to pay FTC the sum of One Hundred Dollars ($100.00). If the equipment is damaged at any time as a result of customer’s negligence, customer will pay the cost of repair or replacement of said equipment up to a maximum of One Hundred Dollars ($100.00). Customer may, at customer’s option, pay for the use of this equipment at the commencement of service for the sum of One Hundred Dollars ($100.00). Any cost of repair or replacement of customer-owned equipment, regardless of cause, shall be the customer’s responsibility.
I AGREE TO THE PURCHASE OF SERVICES UPON THE ABOVE STATED CONDITIONS.