VC - Request New Services

To request new service or to change existing services, please fill out the form below. Once your form is submitted, a customer service representative will contact you within 48 hours.

Name:
Home Telephone:
Work Telephone:
Fax Number:

Address:
City:
State:
Zip Code:
Email Address:

Please check all of the services you would like to request:

1. Select Phone Service for your area and any extra telephone features you would like to add.
Telephone Service - Please Select Your Area No telephone service De Soto $16.00 Genoa $16.00 La Farge $17.50 Liberty Pole $17.50 Readstown $17.50 Viola $17.50 Viroqua $20.50 Westby $17.50 Yuba $17.50	Add These Common Features Caller ID $3.00 Call Waiting $1.25 Call Forwarding $1.25 Conference Calling $1.50 Three Way Calling $1.25 Voicemail $4.00
2. Select the television and internet services you require either individually or as a bundle.

Pricing for Individual Services
Television I want to bundle my internet and television service. Local Basic $31.47 Basic $54.47 Basic Select $54.47 Expanded Basic $65.12 Optional Additions: Local Basic HD $1.95 Basic HD $5.95 Basic Select HD $8.95 Expanded Basic HD $8.95 PVR Service $9.95
Broadband Internet I want to bundle my internet and television service. 1 Meg Down $49.95 2 Meg Down $52.95 3 Meg Down $54.95 7 Meg Down $59.95 10 Meg Down $64.95 15 Meg Down $77.95 20 Meg Down (requires fiber optics) $149.95	Dial-up Internet 5 Hour Dial-up $7.95 Unlimited Dial-up $19.95
Pricing for Television/ High-Speed Bundles
I dont't want a television/internet package
Local (24 channels) plus: 1 Meg Down $66.42 2 Meg Down $69.42 3 Meg Down $71.42 7 Meg Down $76.42 10 Meg Down $81.42 15 Meg Down $94.42 20 Meg Down (requires fiber optics) $166.42	Basic (61 Channels 46 Music Channels): 1 Meg Down $89.42 2 Meg Down $92.42 3 Meg Down $94.42 7 Meg Down $99.42 10 Meg Down $104.42 15 Meg Down $117.42 20 Meg Down (requires fiber optics) $189.42

Select (72 Channels): 1 Meg Down $89.42 2 Meg Down $92.42 3 Meg Down $94.42 7 Meg Down $99.42 10 Meg Down $104.42 15 Meg Down $117.42 20 Meg Down (requires fiber optics) $189.42	Expanded Basic (109 Channels 46 Music Channels): 1 Meg Down $100.07 2 Meg Down $103.07 3 Meg Down $105.07 7 Meg Down $110.07 10 Meg Down $115.07 15 Meg Down $128.07 20 Meg Down (requires fiber optics) $200.07


Options for both individual and bundled television and internet
How many cable boxes do you require? One $0.00 Two $4.00 Three $8.00 Four $12.00	Add additional Meg up $20.00 (requires broadband internet selection)

3. Select from our Web Hosting and Other services if you wish..
Domain Hosting None Microsoft Web Pages $25.00 Virtual Domain Hosting $20.00 Microsoft Domain Hosting $29.95	Off Site Secure Data Storage None Basic 2GB (home use only) $4.95 Basic 2GB (home use only) $4.95 Expansion 5GB (home/business use) $5.00 Enhanced 5GB (home/business use) $9.95 Static IP Address $10.00

Estimated Monthly Service Charge (not including taxes & fees): $

By submitting this form, you are requesting information about services from Vernon Communications and Vernon Telephone Cooperative. This form does not constitute a binding contract and a service deposit may be required upon completion of a credit check.

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