Adams Fiber – Connect IL SignUp First Name * Last Name * Date of Birth * Address City State Zip Your Fiberhood Do you rent or own the property? * Own Rent Property Owner Name * Property Owner Contact Number * Is your billing address different than your service address? * Yes No Billing Street Address * Billing City * Billing State * AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Billing Zip * Email Address * (All correspondence including your service agreement, installation scheduler, and billing information will be sent to this email address.) Contact Number * Current Adams customer? * Yes No Ready to Sign up? or just getting info at this time? * I’m ready to Pre-Register & pay $25 to “Lock in my Price for Life”, Save $120/yr off Standard Price I’m interested, but need more info (please continue to fill out form and we will contact you back) Installation includes a 2,000 foot fiber drop. Refer to (i) in terms and conditions for additional information. Customer is responsible for anything in excess of 2,000 feet. (1 ft equals $1.00)Half of the below Drop Cost is due today. Adams Estimated Total Drop Length (ft) Customer is responsible for: Customer responsibility is 1/3 the excess drop footage. Drop Fee Due Today Drop Fee Due Later Pre-Registration / Drop Fee Due Total Pay Pre-Registration sign-up and Drop Fee Due Today Options * Via Paypal with Credit or Debit Card By Contacting Adams at 217-214-3423 Bill My Adams Account Pay By Check Internet Service* Please select your Service Package * PackageSpeedPre-Registration PricingStandard InstallationStandard Pricing Ultimate Gigabit 1,000 Mbps$74.95/mo$100.00$99.95/mo Elite 200 Mbps$59.95/mo$100.00$69.95/mo Standard 50 Mbps$49.95/mo$100.00$59.95/mo Click here to see the full pricing guide. Please select your Service Package * PackageSpeedPre-Registration PricingStandard InstallationStandard Pricing Ultimate Gigabit 1,000 Mbps$74.95/mo$50.00$99.95/mo Elite 200 Mbps$59.95/mo$50.00$69.95/mo Standard 50 Mbps$49.95/mo$50.00$59.95/mo Click here to see the full pricing guide. Equipment Fees (required) * Required Equipment Fees ($6.50/mo.) FollowMyNetwork App Take control of your home network to view connected devices on your network, set basic parental controls, set up a guest network, or adjust your SSID and password. Smart Phone is required to utilize application. Free Version ProtectIQ: Network Security – $4.00/month ExperienceIQ: Enhanced Parental Controls – $4.00/month ProtectIQ: Network Security/ExperienceIQ: Enhanced Parental Controls – $8.00/month Not Interested Tech Home Protect Plus – $4.95/mo (4 devices) * Secure IT Plus – antivirus and internet security* FIlehopper – 250 GB of cloud backup storage* Password Genie – password manage, data protection, and password security software Yes, I would like Tech Home Protect Plus No, thank you Preferred Tech Home Install Options I want Tech Home Protect Plus installed now I want Tech Home Protect Plus after my Fiber service is installed TV Service* As a potentially money-saving alternative to traditional TV, we have been offering classes to teach about steaming devices such as Amazon FireSticks or Roku’s, as well as the benefits of services such as Netflix, Sling, or Hulu. Are you interested in information about our Cut the Cord classes? Would you be interested in receiving additional information about these classes? * Yes No, thank you TV Package – Fiber Internet Service is required for Adams Fiber TV PackageStandard PriceStandard InstallationPre-Registration Installation Ultra $152.65/mo*$99.95 fee (1 to 4 TVS) $149.95 fee (4 to 8 TVS)$79.95 fee (1 to 4 TVS) $129.95 fee (4 to 8 TVS) Advanced $92.65/mo*$99.95 fee (1 to 4 TVS) $149.95 fee (4 to 8 TVS)$79.95 fee (1 to 4 TVS) $129.95 fee (4 to 8 TVS) Advanced Lite $84.65/mo*$99.95 fee (1 to 4 TVS) $149.95 fee (4 to 8 TVS)$79.95 fee (1 to 4 TVS) $129.95 fee (4 to 8 TVS) Complete $80.65/mo*$99.95 fee (1 to 4 TVS) $149.95 fee (4 to 8 TVS)$79.95 fee (1 to 4 TVS) $129.95 fee (4 to 8 TVS) Complete Lite $74.65/mo*$99.95 fee (1 to 4 TVS) $149.95 fee (4 to 8 TVS)$79.95 fee (1 to 4 TVS) $129.95 fee (4 to 8 TVS) Locals Plus $36.65/mo*$99.95 fee (1 to 4 TVS) $149.95 fee (4 to 8 TVS)$79.95 fee (1 to 4 TVS) $129.95 fee (4 to 8 TVS) No thanks. I’m not interested in TV Service *All packages require a local broadcast fee of $7.00 per month. Regional sports fees of $5.75 per month will be assessed on the Complete, Advanced, and Ultra packages. All Packages includes free HD programming. 1 set-top box is included. Additional taxes and fees may apply. If you have more than 8 TVS, call (217) 214-3423 for pricing. Upgrade To Whole Home DVR Service – $5.00/mo. When you connect an HD DVR to other Set-top Boxes in your home, each room has access to everything you’ve recorded on any connected TV. Whole Home DVR Service Additional Channel Add-onsTo see the channel lineup click here. Locked In For Life pricing does not apply to TV Packages due to unpredictable Network Provider fees. Variety Pak – $6.45/mo Variety Pak Lite- $5.45/mo Sports Extra – $5.45/mo Team Sports – $4.45/mo Outdoor Sports – $3.45/mo HBO – $20.95/mo Showtime – $17.95/mo Cinemax – $17.95/mo Encore – $7.45/mo Starz – $11.45/mo Starz Encore – $17.95/mo Total Number of TV’s Needing Service. Each Package comes with 1 Set-top Box. Additional Set-top boxes $4.95/mo each * 1 2 3 4 5 6 7 8 More than 8 Do you mind telling us why Currently in a contract Pricing I like my current provider Phone Service Local Phone Service Local Phone $15.00/mo per line No Thank You Includes Unlimited Local Calling, Voicemail & Calling Features, Plus keep your same phone number. Number of Phone Lines * 1 2 Would you like to keep your current phone number? * Yes No Who Is Your Current Phone Provider * Adams AT&T Comcast Frontier Windstream Cass Com Current Phone Number * Current Phone Number Line 2 Long Distance Options * 150 minutes for $5.95/mo. 300 minutes for $9.95/mo. 700 minutes for $19.95/mo. No thanks, I don’t need any long distance Would you like voicemail included with your phone line? Please note that voicemail is not needed if you currently use an answering machine. * Yes, I would like voicemail included No thanks, I will keep my answering machine Would you like your number listed in the Quincy Area Wide Directory? * Yes, I would like my number listed in the Quincy Area Wide Directory No, I would like to be Non-listed No, I would like to be Non-Published ($1/mo) Your name, address, and phone number are not published in the Quincy Area Wide Directory, but your telephone number is available from Directory Assistance. Your name, address, and telephone number are not published in the Quincy Area Wide Directory and is not available from Directory Assistance.” How would you like your name listed? * UPS Battery – Note: Phone service will NOT work in case of power outage without a UPS battery backup installed. This is not mandatory, but without it, access to E911 will not work when power is out. * 8 hour UPS for $2.50/mo 24 hour UPS for $15.00/mo Not at this time Bill Pay Options & Additional Information Bill Pay Options * Email Bill (Auto-Pay / Mail in Payment) Paperbill (addl $2/mo charge) and Mail in Payment Account PIN # * No more than 10 characters. Would you like to add an authorized person(s) to my account? * Yes, I would like to add an authorized person(s) to my account. No, Thank You Authorized Person #1 * Name of person to add to account. Authorized Person #2 Name of person to add to account. How did you hear about Adams Fiber? * Website Cut the Cord Class Web Ad Email Direct Mail (letter/postcard) Yard Sign Vehicle Decal Radio Ad Radio Talk Show TV Ad TV News Story Newspaper Ad Newspaper Article A Friend Door to Door Salesperson Twitter Facebook Event An Adams Fiber Customer Other Please let us know which Sales Rep you talked to, Thanks. Nick Hoffman Brad Dooley Brenda Sprague Mike Ridder Ryan Buehler Jeremy Heaton Jess Van Beck Please write in anything that our construction crews need to be aware of in your yard. (Dog Fence, Sprinkler System, etc) Questions or Comments Terms and Conditions * I agree to Terms and Conditions If you are human, leave this field blank.