Northwest Communications - Web Design and Hosting, eCommerce, Shopping Cart
    

 

 

DSL Internet Application

*Denotes Required Fields

INTERNET PLANS
   
  * You must choose from one of the below plans.
   
  All Residential Plans include: Equipment, 5 emails, virus filtering, spam filtering on primary email, web browser content filtering.
   
  Residential 10Mb/1Mb* - $39.95/Month - Plus $75 Installation
  Residential 9Mb/3Mb* - $59.95/Month - Plus $75 Installation
  Residential 12Mb/3Mb* - $79.95/Month - Plus $75 Installation
  Residential 15Mb/5Mb* - $139.95/Month - Plus $75 Installation
   
  All Business Plans include: Equipment, 10 emails, virus filtering, spam filtering on primary email, and web browser content filtering. Website hosting also available for an additional charge.
   
  Business 10Mb/1.5 Mb - $49.95/Month - Plus $75 Installation - Price good with Telephone Service, Price varies otherwise.
  Business 12Mb/3 Mb - $79.95/Month - Plus $75 Installation - Price good with Telephone Service, Price varies otherwise.
  Business 15Mb/5 Mb - $139.95/Month - Plus $75 Installation - Price good with Telephone Service, Price varies otherwise.
  Business 15Mb/10 Mb - $249.95/Month - Plus $75 Installation - Price good with Telephone Service, Price varies otherwise.
  Business 15Mb/15 Mb - $299.95/Month - Plus $75 Installation - Price good with Telephone Service, Price varies otherwise.
     
     
 

*Speeds dependent on network activity.

Customers with critical requirements, such as hospitals, governmental agencies and large organizations - call for pricing. Direct circuits available in most areas.

Standard Installation includes installation of wireless equipment and connection to one computer. Installations that require extraordinary time or resources will be billed an additional charge. Customer will be informed of charges prior to installation. Customers requiring connection of two or more computers will be charged $75 per hour plus additional materials. Monthly service charge includes use of Northwest's antenna and transceiver equipment. Ownership is retained by Northwest Communications.

     
 

SecureIT Application

Addittional Comments:

   
CUSTOMER INFORMATION
  *Are you currently a Northwest Internet Customer?
Yes No
  *If "yes", do you want to disconnect your dial-up account after wireless installation?
Yes No
     
 
*Email address of person
completing this form:
     
 
Your current email address,
if different from above:
     
  Service Address
 
*First Name:
 
*Last Name:
 
*Street Address:
 
*City:
 
*State:
 
*Zip:
     
  Billing Address
 
Billing Name (if different):
 
Mailing Address:
 
City:
 
State:
 
Zip:
     
 
*Home Phone with Area Code:
 
Work Phone with Area Code:
 
FAX (With Area Code):
 
County:
     
 
*Location of service:
 
If Rent, Landlord's Name:
 
Landlord's Phone Number
     
 
Your Driver's License or SS Number:
 
Your Federal Tax ID Number:
 
*Your Mother's Maiden Name (For Security):
     
 
How did you hear about this service?
     
     
E-MAIL ADDRESSES
   
  EMAIL GUIDELINES
Email address must be sixteen characters or less with no punctuation. Email password must be at least 6 characters with some being alphabetical, numerical, and upper case. If address and/or password is unacceptable or unavailable, one will be chosen for you.
   
  Primary E-Mail Address
 
1st Requested Choice
 (Or current NCN e-mail address):
@ncn.net
 
2nd Requested Choice
(if 1st isn't available):
@ncn.net
 
Requested Password
 
Would you like spam filtering activated on this e-mail account?
Yes    No
 
I already have an email account
and will not need one with this service:
     
 
*Would you like Web Content Filtering?
Yes    No
  Click here for more information regarding these options!
     
 

Virus e-mail filtering included with every account. Spam e-mail filtering and Web Content Filtering
are included free with some accounts. See plan descriptions for details.

Cost of these services when not included in plans: Spam Filtering - $3.00 per month;
Web Content Filtering - $5.00 per month; Spam & Content Package - $6.00 per month

Filtering Activation fee is waived if connected at time of Internet installation; $10 fee for Spam Filtering,
$25 fee for Content Filtering if activated later.

     
  Additional E-Mail Addresses
  Residential accounts receive 2-10 emails and business accounts receive 5-10 email addresses depending on speed. You may request additionals for $3/month for residential and $5/month for business accounts.
     
 
1st Additional E-Mail Address:
@ncn.net
    Include spam Filtering
 
Requested E-Mail Password
     
     
 
2nd Additional E-Mail Address:
@ncn.net
    Include spam Filtering
 
Requested E-Mail Password
     
     
 
3rd Additional E-Mail Address:
@ncn.net
    Include spam Filtering
 
Requested E-Mail Password
     
     
 
4th Additional E-Mail Address:
@ncn.net
    Include spam Filtering
 
Requested E-Mail Password
     
     
COMPUTER SYSTEM
     
 
Minimum
Recommended
Memory: 512 MB of RAM
PC OS: Windows XP
MAC OS: OSX

Memory: 1 GB or More
PC OS: Windows Vista or 7
Mac OS: OSX 10.6

*Must have Ethernet card.
  We do not support any PC operating system older than Windows XP
     
SALES INFORMATION
     
 
Sales Agent or Buddy:
 

Buddy credits will not be paid on applications taken to Authorized Northwest Sales Agents.

Recruit-A-Friend/Buddy Program - Refer someone to sign up for Northwest Communications and
you can earn $10 for dialup service. Some restrictions apply.
     
     
PAYMENT INFORMATION
     
  *Please bill me monthly via:
Mail      Credit card      Debit my checking account automatically

For automatic bank deduct and credit card payments, click here to download the form to mail.
Credit Card | Bank Deduct
Please complete the form and mail it to our office at 844 Wood St., Havelock, IA 50546.
     
     
CUSTOMER SERVICE AGREEMENT
     
  I understand and acknowledge that continued use of Northwest's Services constitutes acceptance of the Terms of Service, Acceptable Use Policy and other important policies posted on Northwest's website www.ncn.net. I agree it is my responsibility to read these policies and comply fully with their terms. I further understand the policies and pricing of Northwest's Servicesmay change fromtime to time upon 30 days notice. The Service is provided on an "AS IS" and "ASAVAILABLE" BASISWITHOUTWARRANTIESOFANY KIND, EITHER EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO WARRANTIES OF TITLE OR IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. If service is cancelled, customer agrees to return equipment in working order within 10 business days or pay an equipment charge of $100-$800.
     
  I accept and understand the Customer Service Agreement and the Standard Installation Terms.
  If you do not agree, click this button to exit without submitting this application: 
     
  Please enter the following security code in the next field. For ease of use, only the characters 1 - 9 and A - F are printed. You may enter upper or lower case characters.
 
     
   
     

 


 
   
 
i wireless
800-249-5251 | Email | Northwest Telephone
Microsoft Small Business Specialist