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SERVICE AGREEMENT/CHANGE IN SERVICE


Name

Service Address

City

Zip Code

Account Number

Contact Number

Email Address


Service Address:

Add Service
Upgrade to Fiber

Service Agreement:

12 Month**
24 Month**

Services not available in all areas. Actual Internet connection speed may vary
due to various factors including network congestion and distance from subscriber
to Citizens’ facilities. Electrical surge protection is strongly recommended.
Free installation and free modem require 12-month minimum commitment and is for
one computer only. Internet system requirement: any operating system that
supports your NIC (Ethernet card), Windows 98SE or higher, Mac OS 9 or higher.
Federal, state, local taxes, and service fees are not included in pricing. Some
restrictions may apply and subject to preapproval. Service Agreement required to
waive installation fees. Credit terms apply. **Service Agreement required for
Fiber to the Home services. Standard Connection fee $399. $299 with 12-month
Agreement; $199 with 24-month Agreement.

I have reviewed and read the Terms and Conditions associated with this service
(below) and acknowledge I can access online at https://citizens.coop/terms/
From time to time, Citizens may contact you regarding special offers and
promotions. If you do not wish to receive such information, you may “Opt Out” by
checking this box.

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Date

Please send me a copy of this form.

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