Installer_______
Today’s Date __________
Date________
Time_______
Jade Rep. __________
Application for Canopy Wireless Internet
AR#__________
By filling out this application, you agree to a credit check which is required for service. If the credit check is not passed, there will be a deposit of $300.00. The deposit will
be returned to your account after paying the bill on time every month for 12 consecutive months.
If the Installer shows up at your location to do the Installation and you are not there or you change your mind-there will be a trip charge assessment.
Name: _______________________________________________________________________________________________________
Mailing Address: _____________________________________ City:______________________________ State:_____ Zip:__________
Physical Address:_____________________________________City:______________________________State:______Zip:__________
Driving Directions: __________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Send monthly statements via: E-Mail Billing ____ E-Mail Address____________________________________ Regular Mail Billing ____
Home Telephone #________________ Employer _______________________ Work Telephone #__________________ DOB:____________
Social Security # ____________________ Mother’s Maiden Name ________________Drivers License # ______________ State ______
_________________________________________________________________________________________________________________
No
Contract
Add upload- up to
Add upload- after
Mbps
DOWN
5
10
20
Mbps
INSTALL
UP
FEE
PRICE
1
50.00
39.99
1
50.00
49.99
2
75.00
59.99
5 Meg $12.00 per 1 Meg
5 Meg $50.00 per 5 Meg
___ Basic Router ( >3 wireless connections)
___ Premium Router( >3 & <6 wireless connections)
Amount___ Meg
Amount___ Meg
$110.00 plus tax to purchase
$149.00 plus tax to purchase
UPGRADE
FEE
.00
.00
25.00
Price____
Price____
$4.99 per month rental
$9.99 per month rental
WPA Password Request: ________________________________________________(Router password)
$3.95 Self Install
$11.95 Install by Jade
___ SecureIT Plus- Antivirus $5.95 per month
What equipment are you going to connect to the Canopy Service? (Please circle)
1 computer, more than 1 computer, wireless computer, router, other devices: ____________________________________________________________
ACCOUNT INFORMATION:
E-mail address:GoJade.org
E-mail addresses can be 2 to 18 characters. Passwords need to be 8 to 20 characters and must have 1 number, 1 special character, at least one
upper-case letter and one lower case letter.
Primary Email: ______________________________________ Password: _______________________
_______________________________________________________________________________________________
Equipment pick-up Fee $95.00+If customer does not bring all equipment back within 10 days of
cancellation.
I agree to pay all charges within 10 days of issuance and to pay all reasonable costs of any collection agency (up to 50 percent of the outstanding bill), attorney, court or
any other miscellaneous fees used by Jade Communications to collect past due amounts. Late charges will be applied if payment is not received by the 10 th of each month.
********There will be a service charge applied to all returned checks and/or credit/debit cards or Electronic Fund Transfer Transactions********
Customer Signature: ________________________________________________________
Date:_________________________
Referred By ________________________________________________________
THIS PAGE FOR
USE ONLY
(Internal Use)
Items
Date
1. Checked Credit Information
Score ______
___________________________
2. Collected installation fee
Check
___________________________
Cash
C/C
___________________________
3. Installation scheduled
___________________________
Installer ______________
4. Programmed
□ Radio □ ATA
Initials
Date/Time ______________
□ Switch
□ Router
___________________________
5. Assigned AR#/Phone# to user account
___________________________
6. Work Order
___________________________
7. Wireless Agreement
___________________________
8. Posted Account in the AR Features File
___________________________
9. Activated account in Admin Tool
___________________________
10. Verified Login Information
User ID ________________________
Password _______________________
___________________________
11. Entered IP Address in IP Table /Admin tool
___________________________
12. Contacted customer to inform of activation
___________________________
13. Stopped BTC features if any
___________________________
NETWORK INFORMATION
IP ADDRESS:_______.________.________._______
DEFAULTGATEWAY:_______._______._______.______
SUBNET MASK:_______._______._______._______
DNS: 206.168.40.6
2nd DNS: 206.168.68.2
Tower Site:____________
Color Code: ___________
___________
___________
WIRELESS INTERNET SERVICE AGREEMENT
This Subscriber Agreement (“Agreement”) is made between Subscriber and Jade Communications, for the provision and use
of wireless Internet service (the “Service”).
1. THE SUBSCRIBER..
The “Subscriber” is at least 18 years of age, is legally able to enter into contracts and is responsible for this Subscriber
account. Multiple members of the same household as Subscriber may share the use of Subscriber’s account.
Subscriber shall supervise and be responsible for any use of the Service by other users of the account. Subscriber
shall pay all fees, taxes, charges and other expenses incurred in connection with the account.
2. THE SERVICE.
The Service consists of high-speed data communications. The Service may contain material that is unsuitable for
minors (persons under 18 years of age).
3. CHANGES TO THE SERVICE.
Provider may at any time change this Agreement, including pricing and billing terms. Provider may discontinue, add
or revise any aspect of the Service in its sole discretion and without notice. In the event that Provider changes this
Agreement, the Service or related pricing or billing terms, Subscriber may immediately terminate this Agreement.
Use of the service after any change constitutes acceptance of such change.
4. FEES & PAYMENTS.
Subscriber shall pay all taxes, fees, charges and other amounts for the Service at the rates in effect for the current
billing period. Provider shall make available to Subscriber a statement for each billing cycle showing payments,
credit purchases and other charges. Payment is due in full each month. If payment is not received before the next
statement, Subscriber may be charged interest on the delinquent balance at the rate of one and one-half percent (1.5%)
per month, prorated on a daily basis. Credit amounts shall not accrue interest. Subscriber shall pay the reasonable
costs of any collection agency (up to 50% of the amount owed), attorney or court used by Provider to collect past due
amounts or to enforce this Agreement. A reactivation fee or deposit may be required before Service is reactivated
after termination. Reactivation may take up to 48 Hours. Provider may sell, assign or transfer Subscriber’s account to
a third party without notice to Subscriber. In the absence of notice, Subscriber must continue to make all required
payments to Provider in accordance with the Subscriber’s billing statement.
5. FAIR ACCESS POLICY.
To facilitate equal Internet access for all subscribers, the Service may be subject to a running average fair access
policy. Fair access establishes an equitable balance in Internet access for all customers regardless of their frequency
or traffic usage. To ensure this equity, Subscriber may experience some temporary throughput limitations. Internet
access is not guaranteed.
6. NO ENDORSEMENT.
Provider does not endorse or in any way vouch for the accuracy or completeness of any content made available
through the Service. Provider does not recommend that such content be relied on by Subscriber without appropriate
verification.
7. USE OF INFORMATION.
Information generated by Provider in connection with the administration of the Service shall be the exclusive property
of Provider. Except to the extent prohibited by applicable law, Provider may distribute, loan, sell or otherwise share
with other person’s information concerning descriptive or related data, which do not rely on providing to recipients
the identity of any particular subscriber or user of the Service. Provider may provide information to courts, law
enforcement agencies and others involved in prosecuting claims or investigations for conduct alleged to be illegal or
to violate or threaten the rights of any person or entity. Subscriber’s communications with Provider may be
monitored for quality control and other reasonable business purposes.
8. SUBSCRIBER CONDUCT.
Subscriber shall comply with all laws, rules, regulations and legal obligations related to the Service and with all
acceptable use policies and procedures established from time to time by Provider. Subscriber shall not use the Service
to conduct any business or activity, or to solicit the performance of any activity, which is prohibited by any law, rule,
regulation or legal obligation. Subscriber shall not intercept e-mail in an unauthorized manner or engage in
“spamming” or any similar conduct. Subscriber shall not resell the Service to a third party.
9. EQUIPMENT.
Subscriber shall maintain and operate suitable and fully compatible terminal equipment and universal power supplies
required to access the Service. All Provider equipment must be connected to a universal power supply. All
transmission equipment remains the property of Jade Communications and will be returned in good working order in
the event the Service is cancelled. In the event that the equipment is not returned or is damaged, the Subscriber will be
assessed a fee of $600.00. PROVIDER MAKES NO REPRESENTATION OR WARRANTIES, EITHER EXPRESS
OR IMPLIED, REGARDING SUCH EQUIPMENT.
10. DISCLAIMER OF WARRANTIES.
ACCESS TO THE SERVICE IS NOT GUARANTEED. THE SERVICE IS DISTRIBUTED ON AN “AS IS” AND
“AS AVAILABLE” BASIS WITHOUT WARRANTIES OF ANY KIND, EITHER EXPRESS OR IMPLIED,
INCLUDING BUT NOT LIMITED TO WARRANTIES OF TITLE OR IMPLIED WARRANTIES OF
MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE OR OTHERWISE.
11. LIMITATION OF LIABILITY.
NEITHER PROVIDER NOR ANY OF ITS INFORMATION OR CONTENT PROVIDERS, SERVICE
PROVIDERS, LICENSORS, EMPLOYEES OR AGENTS SHALL BE LIABLE FOR ANY DIRECT, INDIRECT,
INCIDENTAL, SPECIAL, PUNITIVE OR CONSEQUENTIAL DAMAGES ARISING OUT OF SUBSCRIBER’S
USE OF THE SERVICE OR INABILITY TO USE THE SERVICE OR ANY BREACH OF ANY
REPRESENTATION OR WARRANTY. IN ANY EVENT, NO SUCH LIABILITY SHALL EXCEED THE
TOTAL AMOUNT ACTUALLY PAID BY SUBSCRIBER FOR SERVICES PROVIDED UNDER THIS
AGREEMENT FOR THE PRIOR THREE MONTH PERIOD.
12. INDEMNITY.
Subscriber assumes all risk and liability for any use of the Service. Subscriber agrees to indemnify Provider against
all claims, liability, damages, costs and expenses, including but not limited to reasonable attorneys fees, arising out of
or related to the use of the Service.
13. THIRD PARTY BENEFICIARIES.
The provisions of Sections 9, 10 and 11 are for the benefit of Provider and its respective contractors, information or
content providers, service providers, licensors, employees and agents; and each shall have the right to assert and
enforce such provisions directly on its own behalf.
14. CUSTOMER CARE CENTER.
Subscriber shall direct all inquiries and service related issues to Provider’s Customer Care Center below:
Jade Communications
PO Box 1138
129 Santa Fe Avenue
Alamosa, CO 81101
719-589-5140 719-206-8118
btc@gojade.org
15. APPLICABLE LAWS.
This Agreement shall be governed by the laws of State where the principle offices of Provider are located, excluding
its conflicts of law provisions. Any cause of action of Subscriber, or by users of Subscriber’s account, with respect to
the Service of this Agreement must be instituted within one year after the claim or cause of action has arisen or be
barred. It is acknowledged that this is a services contract and not a contract for the sale of goods.
16. MISCELLANEOUS.
This Agreement and any additional documents referred to in this Agreement constitute the entire and only agreement
with respect to the subject matter and are applicable to Subscriber and all users of Subscriber’s account. This
Agreement supersedes all representations, agreements and other communications with respect to the subject matter
except as expressly set forth in this document. This Agreement can be amended only by a written document signed
by the parties or as otherwise provided herein. Neither the course of conduct between the parties nor trade practice
shall modify the provisions of this Agreement. If any term of this Agreement is found by a court of competent
jurisdiction to be invalid, illegal or unenforceable, the Agreement shall be construed in such a way as to eliminate the
offending term while giving as much effect as possible to the intentions of the parties. Provider may authorize or
allow its contractors and other third parties to provide services necessary or related to performance under this
Agreement and may collect payment on their behalf. Notice under this Agreement may be made by any reasonable
means, including e-mail, postal service or publication over the Service.
Print Name: _______________________________________________________________________________
Signature:
________________________________________________ Date: ________________________
Digital Phone with Canopy Service: $19.99 / Month
Application for Digital Phone Service $24.95 / Month for stand-alone phone
Name: _______________________________________ Email: _____________________________ AR# ________
Mailing Address: _____________________________ City: ______________________State: _____ Zip: _________
911 Address: ________________________________ City: _______________________State: _____ Zip:_________
Driving directions: _______________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Contact Telephone#: ________________Cell #_______________ Work #_______________
*****We must have a different contact # other than the # we are programming!!**********
Social Security #:__________________________ Drivers License#:______________________ State____________
CALLING FEATURE SELECTION INFORMATION:
FEATURES: The following calling features are automatically added to your telephone line FREE of charge. Usage
instructions are attached. 1) Call Waiting 2) Caller ID 3) Call Forwarding 4) Conference Calling 5) Speed Dialing
6) Caller ID Blocking 7) Caller ID Release 8)Voice Mail Gold 9) Call Forward Busy 10) Call Forward Don’t Answer
Unlimited Long Distance in the Continental US (excluding directory assistance)
Do you want to port your current phone #? (yes, no ) What is the #? _____________Copy of Bill: _____
********DO NOT DISCONNECT YOUR TELEPHONE SERVICE FROM YOUR CURRENT PROVIDER***********
Equipment Required:
ATA (to be returned upon disconnect or $110.00 Charge)
UPS highly recommended
Listing Options:
Yes No Please list name in the Telephone Directory as follows:
_______________________________________ If No, a $0.50 per month charge applies.
Yes No Please list this name with Directory Assistance. If No, a $0.50 per month charge applies. If you select NO your number will not be released
for Caller ID purposes and “Private” will show on the called parties’ phone. If you select YES here, your number will be provided to Caller ID systems.
Some subscribers will have their incoming calls blocked to “Private” calls.
Credit Card Information
We can accept your monthly payment by credit card. Please provide the following information.
Name on Credit Card: _____________________________________________________________
Credit Card Type :( circle one) Master Card
Visa
Discover
Credit Card #:___________________________________ Exp Date: _______________________
Date for Monthly Reoccurring Payment (Choose a date between the 3rd & 10th):______________________________
By completion of this application or the use of the services provided by Jade Communications the customer agree to pay all
charges within 10 days of issuance. If collection or legal action occurs the applicant agrees to pay the outstanding charges
plus
50% of the outstanding bill for collection plus all reasonable attorney fees and court costs used to collect the amount.
Signature______________________________________________Date:______________________________
Important Calling Information including 911
We are pleased to offer you digital phone service and want to take this opportunity to advise you of certain calling features and 911
capabilities. Your safety and that of your family and friends are important to us at Jade Communications. While we hope that the
occasion never arises where our Enhanced 911 feature is needed, in case it is, we want to remind you of both its capabilities and any
limitations associated with its use.
The Federal Communications Commission (FCC) has asked the industry to make sure you understand this important information
about digital phone service. Jade Communications Digital Phone will not function (regular or 911 calls) if Jade’s equipment fails or is
relocated from the current premises or tampered by the customer. Additionally, regular calls and 911 calls will not function if the Jade
equipment is interrupted or not functioning for any reason or if the customer’s power is non-functional. This may include, but is not
limited to, power outages lasting beyond the current backup provided by Jade Communications or network outages just like traditional
telephone service.
The service agreement is violated if the customer’s equipment is moved from the physical location where it was originally installed.
This will cause 911 communications to be misdirected to an incorrect emergency services responder.
The customer is totally responsible for all power at the customer’s location. Since power outages do occur, Jade Communications
recommends that an Uninterrupted Power Supply, and surge arrestor be purchased, installed and maintained on the high speed internet
circuit which is connected to the ATA and telephone. All wires from other telephone companies connected at the interface box located
outside must be disconnected.
We hope this information will assist you in using your Digital Phone Service to its fullest potential. Please take a minute to
acknowledge your understanding and receipt of this information by signing below.
“Be advised that any services provided through this equipment are not intended to replace or be a substitute for primary line voice
services or Plain Old Telephone Service (POTS) and are not meant to provide guaranteed 911 or E911 services or to permit access to
411 directory assistance services. Your service provider, not Motorola, is responsible for the provision of Voice over IP (VOIP)
telephony services through this equipment. Motorola shall not be liable for, and expressly disclaims, any direct or indirect liabilities,
damages, losses, claims, demands, actions, causes of action, risks, or harms arising from or related to the services provided through
this equipment. Important: be aware that you will not be able to make any calls using this Voice over IP (VOIP) device if your
broadband connection is not functioning properly. You will also not be able to make any calls using this Voice over IP (VOIP) device
if you have lost electrical power.”
Thank you for your continued business,
Jade Communications, LLC
I understand the above information about my Digital Phone Service.
Signature: _____________________________________________ Date _______________________
Print Name: _________________________________________________________________________
911 Address: ________________________________________________________________________
Phone Number: ______________________________________________________________________
CUSTOMER COPY
 Customer Name: _______________________________________________________
 Customer Address: _____________________________________________________
 City, State, Zip: ________________________________________________________
 Telephone Number: ____________________________________________________
 Phone Book Listing: ___________________________________________________
Important Calling Information including 911
We are pleased to offer you digital phone service and want to take this opportunity to advise you of certain calling features
and 911 capabilities. Your safety and that of your family and friends are important to us at Jade Communications. While we
hope that the occasion never arises where our Enhanced 911 feature is needed, in case it is, we want to remind you of both its
capabilities and any limitations associated with its use.
The Federal Communications Commission (FCC) has asked the industry to make sure you understand this important information
about digital phone service. Jade Communications Digital Phone will not function (regular or 911 calls) if Jade’s equipment fails or is
relocated from the current premises. Additionally, regular calls and 911 calls will not function if the Jade equipment is interrupted or
not functioning for any reason. This may include, but is not limited to, power outages lasting beyond the current backup provided by
Jade Communications or network outages just like traditional telephone service.
The service agreement is violated if the customer’s equipment is moved from the physical location where it was originally installed.
This will cause 911 communications to be misdirected to an incorrect emergency services responder.
The customer is totally responsible for all power at the customer’s location. Since power outages do occur, Jade Communications
recommends that an Uninterrupted Power Supply, and surge arrestor be purchased, installed and maintained on the high speed internet
circuit which is connected to the ATA and telephone. All wires from other telephone companies connected at the interface box located
outside must be disconnected.
We hope this information will assist you in using your Digital Phone Service to its fullest potential.
Thank you for your continued business,
Jade Communications, LLC
FEATURE DIRECTIONS:
CALL FORWARDING: Automatically forward your calls to another location when you plan to be away from your telephone for
an extended period of time or if you do not wish to receive any calls. Note that you, not the originating party, are billed
or any toll charges when the forward-to-number is outside your local area.
Step
Description
1
Dial *72 and wait 4 seconds for a dial tone.
2
Dial the forward-to-number. When the station to which calls are to be forwarded answers, the feature is
activated. If the station does not answer or if it is busy, you may hang up and repeat the previous steps. If
this is done within 2 minutes of the original attempt, you will hear two beeps, indicating that the call
forwarding feature is now in effect.
3
To deactivate call forwarding and restore normal service, dial *73 and wait 4 seconds for 2 bursts of dial tone,
then hang up. All subscribers may avoid the time out period by dialing an octothorp (#).
THREE WAY CALLING (3 PARTY CONFERENCE): Three way calling allows you to have two other parties on the line with you
simultaneously.
Step
Description
1
Depress and release the hook-switch to put the original party on hold. Listen for three bursts of a dial tone
followed by a steady dial tone.
2
Dial the number of the third party. When this party answers, you can talk privately. When you are ready
to establish the conference connection, depress and release the hook-switch.
3
When the originating party hangs up, all parties are disconnected and the call is completed.
SPEED DIALING: Program your phone to dial frequently called numbers with fewer keystrokes. Up to 8 numbers may be
programmed.
Step
Description
1
Dial *74 and wait 4 seconds for a dial tone.
2
Dial a code number (use a number between 2 and 9 inclusive).
3
Dial the directory number to be stored with the corresponding code. Wait 4 seconds for 2 bursts of dial tone,
then hang up.
4
Repeat steps 1 - 3 for each number to be stored, using a different code each time. You may use these steps to
replace previously stored numbers.
5
To use speed dialing, dial the selected code number and wait 4 seconds for the call to be placed.
CALL WAITING: Call waiting allows you to be notified of incoming calls while you are engaged in a conversation. Using the steps
below, you can answer the incoming call without terminating your existing conversation.
Step
Description
1
An alert tone gives notification of an incoming call. To answer the call, depress and release the hook-switch.
This puts the original party on hold, and you are then connected to the calling party.
2
To alternate between calling parties, depress and release the hook-switch.
3
If you wish to end the original conversation when you hear the call waiting tone, simply hang up. Your call
then rings and you are connected to the calling party.
CALLER ID RELEASE: If you choose not to be listed in Directory Assistance your phone listing for Caller ID systems will be listed as
“Private” instead of releasing your phone number. Some people have their phones blocked to accept calls from “Private” callers. If
you
are listed as “Private” and desire to have your number released for one call, please follow the directions below prior to placing the
call.
Step
Description
1
Dial *82 to cause your number to appear on the calling party’s telephone or Caller ID system.
CALLER ID BLOCKING: If you choose to be listed in Directory Assistance your phone number will be provided to Caller ID systems.
Caller ID Blocking allows you to prevent your number from being displayed on other Caller ID telephones on a per-call basis. In lieu of
your number being displayed, the word “Private” will appear instead. Please follow the directions below to block your number from
being
displayed prior to making your call.
Step
Description
1
Dial *67 to cause a “Private” to be displayed on the calling party’s telephone.
M:\Documents\Jade\Canopy\Application for Canopy Wireless Internet