212 Medical Onboarding Form

Medical Kits Onboarding Form

Get Onboarded for the Medical Kits Campaign

We're excited to have you join the medical kits campaign! To get started, please provide your name and email address below. Once you complete the form, you will receive an email with your login link within 24 hours.

What to Expect Next

After submitting your information, you will receive an email with a link to create your account. Please check your spam folder if you do not see it in your inbox.

Once you have created your account, you will be able to access the campaign dashboard and start tracking your progress.

We look forward to having you on board!

Sincerely,

Brand Troops Inc on-boarding team

First Name

Last Name

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Consolidated Communications Fiber Internet Order Form

CUSTOMER INFORMATION

Customer Name

Additional Name

Service Address

City

State

Zip

4 Digit PIN

Phone #

Email Address

Security Question 1

Answer

Security Question 2

Answer

Fiber Internet Service

1 Gig $70.00/mo*

250 Mbps $60.00/mo*

50 Mbps $35.00/mo*

*Limited-time offer for first year of residential internet service. Prices are before taxes and surcharges. WiFi equipment required; included in advertised price. Standard rates apply after promotion. No annual contract. Service availability, speed and uninterrupted service not guaranteed. Wireless speeds vary.

Internet Features

Dedicated connection & bandwidth

Wireless modem included

Speeds to handle all connected devices

Symmetrical upload and download speeds

No data cap

30-day money-back guarantee

Free professional installation

THIS DOCUMENT DESCRIBES THE TERMS AND CONDITIONS UNDER WHICH CONSOLIDATED COMMUNICATIONS PROVIDES ITS INTERNET SERVICE. IF YOU DO NOT ACCEPT THESE TERMS AND CONDITIONS, PLEASE NOTIFY US IMMEDIATELY AND WE WILL CANCEL YOUR ORDER.

Customer Name

First

Last

Sales Rep Name

First

Last

Customer Signature

Clear

Sales Rep Signature

Clear

Date

Preferred Install: 1st Date

AM/PM

Preferred Install: 1st Date time

2nd Date

AM/PM

Preferred Install: 2nd Date time

3rd Date

AM/PM

Preferred Install: 3rd Date time

Monthly Price

Plus Taxes and fees

New Order

Quote

General terms and Conditions

The terms and Conditions below, along with the accompanying information, constitute and Agreement between Consolidated Communications (here after
called “CCI”) and the subscriber of High-Speed Internet. Subscription to and use of Service(s) will constitute acceptance of this
Terms and Conditions, you (the “Subscriber” of CCI Services) will be referred to as the “Customer.” For more detailed terms and
Web site at: www.consolidated.com.
Access to Premises: Customer warrants that Customer is the owner of, or tenant in, the premises and is authorized to enter into and perform this Agreement.
Customer grants to CCI, or it’s agents, the right to enter Customer’s premises for the purposes of connecting, disconnecting, auditing, repairing and removing
any equipment installed or Service(s) provided by CCI.
Pricing of Service(s): Pricing shall be applied according to our pricing guidelines as listed on available documents in our business offices and on our Website.
Pricing is subject to change without prior notification.
Content Resale: Whether implied or not, no content obtained through CCI Service(s) shall be misused or resold without the written permission of CCI and the
content provider pursuant to CCI operating policies and restrictions of law.
Inside Wiring and Installation: Customer acknowledges that the inability of CCI technicians to access Customer’s facilities and/or other operational
impediments may preclude or delay delivery of Service(s) as may have been scheduled or promised. Customer acknowledges that CCI installation technicians
may require inside wiring in order to complete Service delivery beyond Basic Installation guidelines, at additional charges per an hourly rate and/or other
charges. Customer further acknowledges that this charge will occur at the sole discretion of the installation representative.
Equipment: During the term of this Agreement, CCI will install, repair and maintain all equipment and material (excluding inside wire) necessary for the
provision of CCI Service(s) inside or outside the Customer’s premises. Customer agrees that this equipment and associated materials are the property of CCI
and may not be serviced by anyone other than CCI or CCI’s agent(s). Customer agrees not connect, disconnect or tamper with this equipment without CCI’s
consent. Except for cable “home wiring” as that term is defined by Federal or state regulation or law, equipment and materials CCI installs inside and outside the
Customer’s premises are and will remain CCI’s property, including any equipment and materials installed or provided by CCI after the date of this Agreement,
unless otherwise purchased from CCI. Customer will not alter, damage or tamper with any equipment owned by CCI. Upon transfer or termination of Service(s)
for any reason, Customer will immediately cease use of any equipment owned by CCI and shall return all equipment with ten (10) days. If Customer fails to
return CCI equipment and either requests a CCI representative retrieve it or one is dispatched to reclaim CCI property, a “Service Call” charge will be added to
the final bill. If Customer fails to return or damages the equipment beyond normal wear and tear, Customer will pay the actual cost of repair and replacement.
Customer agrees that CCI, or its agents, have the right to recover all costs and expenses incurred by CCI in any action deemed necessary to recover equipment
or repair damages to their property.
High-Speed Internet Service:
1. One Ethernet cable of reasonable length, as determined by CCI, will be provided to connect to the Customer’s High-Speed Internet computer equipment if
needed.
2. CCI will provide a high-speed Internet router to allow wireless connectivity in the Customer’s premises. If Customer opts to use their own router, CCI will not
manage or troubleshoot the router in the event there is an issue with wifi connectivity.
3. If CCI installs a CCI router, the installation technician will connect it to one device, either wired or wireless and provide directions to the Customer to connect
additional devices.
All CCI features/services are sold subject to terms and conditions contained in applicable tariffs and/or price guides. Any inconsistency between this information
and such tariffs and/or price guides will be resolved in favor of such tariffs and/or price guides. Features and/or services are available where facilities permit.

Notice of Cancellation

Date of Transaction

YOU MAY CANCEL THIS TRANSACTION WITHOUT ANY PENALTY OR OBLIGATION WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. IF YOU CANCEL,
ANY PROPERTY TRADED IN, ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE, AND ANY NEGOTIABLE INSTRUMENT EXECUTED BY YOU
WILL BE RETURNED WITHIN 10 BUSINESS DAYS FOLLOWING RECEIPT BY THE MERCHANT OF YOUR CANCELLATION NOTICE, AND ANY SECURITY INTEREST
ARISING OUT OF THE TRANSACTION WILLL BE CANCELLED. IF YOU CANCEL, YOU MUST MAKE AVAILABLE TO THE MERCHANT AT YOUR RESIDENCE, IN
SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED, ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE; OR YOU MAY IF YOU WISH,
COMPLY WITH THE INSTRUCTIONS OF THE MERCHANT REGARDING THE RETURN SHIPMENT OF GOODS AT THE MERCHANT’S RISK AND EXPENSE. IF YOU
DO NOT AGREE TO RETURN THE GOODS TO THE MERCHANT OR IF THE MERCHANT DOES NOT PICK THEM UP WITHIN 20 DAYS OF THE DATE OF YOUR
NOTICE OF CANCELLATION, YOU MAY RETAIN OR DISPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION. TO CANCEL THIS TRANSACTION, NOT
LATER THAN ___/____/____ (THREE DAYS FROM DATE ABOVE), MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY
OTHER WRITTEN NOTICE TO CONSOLIDATED COMMUNICATIONS AT 2117 S. 17TH STREET, MATTOON, IL 61938, ATTN: CONTRACT DEPARTMENT.
I HEREBY CANCEL THIS TRANSACTION.

Date

Buyer’s Signature

Clear

If you are human, leave this field blank.

212 Medical Onboarding Form

Medical Kits Onboarding Form

Consolidated Communications Fiber Internet Order Form

CUSTOMER INFORMATION

Fiber Internet Service

Internet Features

General terms and Conditions

Notice of Cancellation

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