Sign Up 1Services2Internet3Phone4Streaming5IT Services6Contact Information78New/Existing Customer(Required)Will you be establishing service for the first time with Wilson Communications? New ExistingWhich services are you interested in?(Required) Internet Phone Streaming Home IT ServicesAccount Number(Required)Contact Telephone Number(Required)New Account InformationResponsible Billing Name on Account (Must match required ID)(Required) First Last Date of Birth MM slash DD slash YYYY Email(Required) Contact Telephone Number(Required)Place of EmploymentEmployer Contact Telephone NumberResidential Address(Required)Please provide the physical address of where the service is to be installed. Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mailing address My mailing address is different than my residential addressMailing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code By designating authorized parties on your account, you authorize the individual(s) to transact changes in account information and services, have access to account information, including service charges, account balances and transactions. You have the right to revoke this authorization at any time for future disclosures. All parties listed above will be required to provide the CPNI listed above in order to make any inquiries or changes to this account. This authorization must be revoked in writing.Additional Authorized Party on AccountI designate the following individual(s) as an additional authorized party on my Wilson Communications’ account. This designation applies to all services and account information. Include a contact number for each authorized party.John Smith, 012-345-6789CPNI (Customer Proprietary Network Information)1st Level Authentication(Required)Please choose one of the following and provide an answer.What are the last for digits of your SSN?What city were you born in?What is your favorite color?What is your mother's maiden name?What street did you grow up on?Answer(Required)Account Password(Required)Please provide a password that is made up of non-biographical information, not related to you, your name, address, initials, social security number, TIN, telephone number, etc. It can contain letters, numbers or characters.Forgot password Question(Required)Please choose one of the following and provide an answer.What is the name of your favorite pet?What is your favorite food?What is your favorite football team?What is your favorite restaurant?What was the color of your first house?Answer(Required)Internet Service(Required) FORCE 75: 75 Mbps/75 Mbps $62.95/month FORCE 100: 100 Mbps/100 Mbps $79.95/month FORCE 275: 275 Mbps/275 Mbps $99.95/month FORCE 1G: 1,000 Mbps/500 Mbps $199.95/monthTransmission speeds may vary based upon distance between wireless capable equipment and gateway and technology type of the wireless equipment.Requested Internet Username(Required)Please select a username for your internet account. This will also be the beginning of your email address. (Example: [email protected]) The username needs to be 6-10 lower-case characters. The username may contain numbers but is not required.)Email Password(Required)Please select a password for your internet service. The password must be minimum of 12 characters to 127 characters in length and have at least 3 lowercase, 3 uppercase and 3 numbers and/or symbols. Password must not match your username.Optional Services I would like to lease a router Inside Wire Maintenance Purchase Router I have my own routerOne-Time Charges(Required) Standard Professional InstallationThis field is hidden when viewing the formInternet One-Time ChargesThis field is hidden when viewing the formInternet Monthly ChargesPhone Residential Home TelephoneIncludes applicable fees: Residence City or Residence Rural ($19.00)Resident Interstate Access ($6.50)Residence Access Recovery Charge ($1.72)FUSC ($2.36), and County 911 Charge ($.90)Calling Features Inside Wire Maintenance Caller ID Voicemail Call Waiting Call Forwarding Unpublished NumberOne-Time ChargesService Connection Fee required on all new service activations. Special Feature Connection is for existing customers only. Service Connection Fee Special Feature ConnectionThis field is hidden when viewing the formPhone One-Time ChargesThis field is hidden when viewing the formPhone Monthly ChargesStreaming Equipment available for purchase Roku Express HD Streaming Player Roku 4K Streaming Stick Additional Roku Voice Remote TiVo Stream 4K Google Chromecast TV 4K Amazon FireTV Stick 4K Max a/ Alexa I do not need any EquipmentThis field is hidden when viewing the formStreaming One-Time ChargesHEA Options HEA Service Monthly Charge HEA Maintenance HEA Additional/replacement band HEA Additional/replacement transmitter I do not need at this timeThis field is hidden when viewing the formHEA One-Time ChargesThis field is hidden when viewing the formHEA Monthly ChargesHOME IT SERVICE PC Support Plan Setup (Single or Household monthly plan only) PC Support Plan Monthly (requires 12 mo commitment) PC Support Plan Annual w/Setup (Year 1) PC Support Plan Annual (Year 2) Household Support Plan Monthly (requires 12 mo commitment) Household Support Plan Ann w/Setup (Year 1) Household Support Plan Annual (Year 2) I do not need at this timeThis field is hidden when viewing the formIT Monthly ChargesMonthly bills are received on the 1st of the month and are due on the 10th of the month. If the account becomes past due, services may be terminated, and reconnection fees will apply. Local service is billed in advance. Toll calls are billed in arrears. For example, a June 1st bill would include toll calls from April 16th through May 15th. Special programs are available for discounts on the Internet and Telephone service for qualifying individuals. Please ask a Customer Service Representative about details for Lifeline or visit https://wilsoncommunications.us/lifeline-program/.* Government taxes and fees will apply. Long distance rates are for continental US calling only. Standard installation fees and service deposit may apply. Broadband speeds may vary. Certain other restrictions may apply.A valid photo ID such as, driver’s license, passport or other comparable ID that has not expired must be provided with this application. Intentionally giving false information will be considered intent to defraud, and the application will be denied. The discovery after the service is established that incorrect information was given on this form will be considered grounds for immediate discontinuation of service.Please upload photo identification.Please upload photo identification.Max. file size: 50 MB.Estimated One-Time TotalEstimated Monthly TotalConsent(Required)I agree and hereby acknowledge that I am the person submitting this form or am an ‘authorized representative’ for this applicant and is submitting this form on their behalf. Furthermore I agree that I am making an application for Internet/Telephone/HEA service and agree to pay established rates for each service. I agree to any general changes in the rules, regulations, tariff or rates for the service(s) furnished. I certify, under penalty of perjury, that the information is true and correct to the best of my knowledge and belief. I agree. See Broadband Labels