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Business Cable & Internet Application

- Thank you for applying for telecommunications services with Independence Light & Power. Please refer to www.indytel.com for complete service descriptions and our terms of service. Contact us at (319) 332-0100 for additional information or if you have any questions. Thank you!
- Your Information
- Company Name
- Federal ID Number
- Phone
- Landlord, Owner or Manager of service address
- Email
- Service Address
  Street Address Address Line 2 City State ZIP Code
- Mailing Address
  Street Address Address Line 2 City State ZIP Code
- CABLE SERVICES
- Package
  - Lifeline Basic (2-38) $22.95
  - Standard Basic (2-95) $65.95
  - Standard Plus (2-136) $75.95 (Box Required)
- Do you have cable now?
  - Yes
  - No
- How many TV’s will be connected?
- Will you need any cable outlets?
  - Yes
  - No
- Other cable services available upon request.
  $29.95 install fee applies if you only subscribe to one service. Install fee is waived if you subscribe to two or more services. Existing outlets plus 2 new outlets are included in the install. Home wiring for extra outlets will be charged at $24.95 per outlet.
- INTERNET SERVICES
  * $29.95 install fee applies if you only subscribe to one service.Rates increase by $10 if you do not subscribe to cable.
- How many devices do you have?
- Do you have a wireless router?
  - Yes
  - No
- What brand?
  (DSL, Netgear, Linksys, Belkin)
- - Add wireless modem for $5/mo.
- Business Rates
  - Business Lite (4Mb Dn/1Mb Up) Email & Light Activity | $39.95
  - Business Standard (20Mb Dn/5Mb Up) Small Business & Home Office | $59.95
  - Exec Business (100Mb Dn/10Mb Up) Medium Sized Business | $79.95
  - Business Fiber (500Mb Dn/50Mb Up) Medium to Large Sized Business | $284.95
- ** If you would like our wireless modem, please provide a Network Name and Password:
- Network Name
- Password
- If not a current utility customer, please complete
- Person responsible for paying the electric bill
  First Last
- Payee Address
  Street Address Address Line 2 City State ZIP Code
- Previous utility provider
- Previous utility provider Address
  Street Address Address Line 2 City State ZIP Code
- Consent*
  Agree
  I have read and agree to all terms of service (available on www.indytel.com or at Independence Light & Power,
  Telecommunications) that I have applied for on this application.
- For Office Use Only
- Initials
- Account#
- Node
- Technician
- Install Date & Time
- PrePay $

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This institution is an equal opportunity provider and employer.

Phone: 319-332-0100
Fax: 319-332-0101
Safety Center: 319-334-2520

700 7th Ave NE
Independence, IA 50644

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