Residential Service Application (Printable)

📋 Applicant Information

Customer Status:

New Customer

Existing Customer

First Name *

Middle Initial

Last Name *

Last 4 of SSN *

Date of Birth *

Driver's License #

Household Size *

Household Annual Income *

I want to sign up for the Fiber Optic Cable to be installed to my house FREE of charge.

📍 Service Address

Physical Street Address *

City *

State *

ZIP Code *

Mailing Address (if different from service address)

Mailing Street Address / PO Box

City

State

ZIP Code

📞 Contact Information

Primary Phone *

Mobile

Home

Work

Alternate Phone

Mobile

Home

Work

Cell / Text Phone

Email Address *

I consent to receive TEXT MESSAGE updates about my account, service appointments, and billing reminders at the number(s) above.

🏠 Property Information

Property Type *:

Owned

Rented

Landlord / Property Owner Name

Landlord Phone

📡 Requested Services

🎉 Special Offer: FREE Fiber Optic Drop Installation! Get your home ready for lightning-fast fiber internet at no installation cost. Not available in all areas.

Fiber Optic Broadband

🦬 The Bison — 100 Mbps Down / 20 Mbps Up$65.00/mo

🐺 The Wolf — 250 Mbps Down / 25 Mbps Up$79.00/mo

🐻 The Bear — 500 Mbps Down / 25 Mbps Up$99.00/mo

🦅 The Eagle — 1 GB Down / 100 Mbps Up$149.00/mo

Wireless Broadband

🦅 The Chinook — 10 Mbps$39.00/mo

🐏 The Ram — 25 Mbps$45.00/mo

🦅 The Hawk — 50 Mbps$55.00/mo

Voice Services & Add-ons

☎️ Basic Residential Phone Line (Caller ID & Long Distance incl.)$17.15/mo

📞 Additional Phone Line$17.15/mo

📧 Voice Mail$8.00/mo

📠 Residential ATA (Fax)$5.00/mo

📡 Residential Router Fee$6.50/mo

🌐 Static IP Fee$10.00/mo

🔌 Port Charge$25.00

🔄 Reconnect Fee$55.00

Some speeds only available on fiber optic network. Some services may require a wireless service. State, local & federal taxes will apply.

Estimated Monthly Total:
$________ +tax

🔐 Security / Challenge Questions

Answers are used to verify your identity if you need account assistance. Kept confidential.

Question #1: Favorite Pet's Name *

Question #2: Name of Your Favorite Teacher *

Question #3: Favorite City *

✍️ Agreement & Signature

By signing below, I confirm: (1) All information provided is true and accurate. (2) I authorize WSTC to obtain consumer credit reports and verify other information to determine service eligibility. (3) I have read and agree to WSTC's Service Agreement, Terms of Service, and Privacy Policy available at wstel.com. (4) A deposit may be required based on credit history. (5) WSTC equipment must be returned upon termination; customer is responsible for unreturned or damaged equipment.

I have read and agree to the Terms and Conditions, Service Agreement, and Privacy Policy.

Signature (Full Legal Name) *

Date *

Additional Notes

🏢 Office Use Only

Received By

Date Received

Account #

Install Notes / Follow Up