Business Service Application
Professional Connectivity Solutions
4202 Holliday St, Warm Springs, OR 97761 | (541) 615-0555 | wstel.com
ENTERPRISE
FIBER &
WIRELESS
SERVICES
FIBER &
WIRELESS
SERVICES
Business Information
Legal Business Name *
DBA / Trade Name (if different)
Business Type *
Federal Tax ID / EIN *
Years in Operation
Primary Contact Information
Contact First Name *
Contact Last Name *
Title / Position *
Primary Phone *
Mobile
Office
Work
Alternate Phone
Mobile
Office
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.
Service Address
Physical Street Address (where service will be installed) *
City *
State *
ZIP Code *
Billing Address (if different from service address)
Billing Street Address / PO Box
City
State
ZIP Code
Property Information
Property Status *:
Owned
Leased
Property Owner / Landlord Name
Property Owner Phone
Requested Services
Business Broadband
Voice Services & Add-ons
Other / Special Service Requests
State, local & federal taxes will apply. Some speeds only available on the fiber optic network.
Estimated Monthly Total:
$________ +tax
$________ +tax
Installation & Access Details
Preferred Installation Date
Best Time Window
On-Site Contact (if different from primary contact)
Special Access Instructions
Security / Challenge Questions
Answers are used to verify your identity and authorize account changes. Kept confidential.
Question #1: Name of First Business Partner or Employee *
Question #2: City Where Business Was Founded *
Question #3: Business Incorporation Year *
Authorization & Signature
By signing below, I confirm: (1) All information provided is true and accurate. (2) I am authorized to enter into this agreement on behalf of the business entity named above. (3) I authorize WSTC to obtain business credit reports to determine service eligibility. (4) I have read and agree to WSTC's Business Service Agreement, Terms of Service, and Privacy Policy available at wstel.com. (5) A deposit may be required based on credit history. (6) WSTC equipment must be returned upon service termination. Business license and authorization documents may be requested during processing.
I have read and agree to the Business Service Terms and Conditions, Service Agreement, and Privacy Policy.
Authorized Signature (Full Legal Name) *
Date *
Title / Position of Signer
Additional Notes
Office Use Only
Received By
Date Received
Account #
Provisioning Notes / Follow Up