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Access Fiber Internet - Business Service Order Form

2. Access Fiber Internet - Business Class Order Form

4. Billing Information

6. Business Name*

8. Service Address*

10. Billing Address (if different)

12. City*

13. State*

14. Zip Code*

18. Contact Information

20. Contact Name*

21. Email Address*

23. Phone Number*

24. Fax Number

28. Service Bandwidth/Speed*
    -- Select One --100Mbps $89.00/Month1Gbps $149.00/Month

    Please select the bandwidth option you'd like to order.

30. Managed WIFI Option*
    -- Select One --City Managed WIFI Router $10.00/MonthI Will Provide My Own Router $0.00

    Please select if you'd like us to provide and manage a WIFI router, or if you'd like to provide your own.

32. Installation Fee*

    1. I understand that once a representative has completed a walk through of the premises and scheduled an installation, there will be a $100 Installation fee that will be on my first bill.

36. Are you the Property Owner?*

    1. Yes
    2. No

    *Note: If you are not the property owner, we may not install fiber Internet until we receive authorization from the property owner, which we will request on your behalf.

38. Right of Entry Agreement
    Right of Entry

    Link to Right of Entry Agreement

39. Right of Entry Agreement

    1. By checking this box I state that I am the property owner or am authorized by the property owner to execute the Right of Entry and Easement Agreement, and that I agree to the Right of Entry & Easement

    *Note: If you are not the property owner, we may not install fiber Internet until we receive authorization from the property owner, which we will request on your behalf.

41. Property Owner/Manager Contact Name

    Contact info for property owner or property manager if customer rents/leases property

43. Phone Number

    Contact info for property owner or property manager if customer rents/leases property

44. Email Address

    Contact info for property owner or property manager if customer rents/leases property

48. Master Service Agreement
    Master Service Agreement

    Link to MSA

49. Accept Master Service Agreement Terms and Conditions*

    1. By checking this box I state that I am at least 18 years of age, that I have read and agree to the Master Service Agreement, and agree to the Acceptable Use Policy.

51. Acceptable Use Policy
    Acceptable Use Policy

    Link to AUP

52. 12 Month Contract*

    1. By checking this box I state that I have the right to make a decision about the property's Internet service connection, and that I accept the 12 month contract term as stipulated in the T&C.

54. Note: The City of Anacortes reserves the right to make changes to the Access Anacortes Fiber Internet policies and agreements, including but not limited to the Master Services Agreement, Acceptable Use Policy, and Right of Entry agreements. The most current versions of all policies and agreements will be available on the Policies & Agreements subpage of the City of Anacortes fiber department website.

    Note: The City of Anacortes reserves the right to make changes to the Access Anacortes Fiber Internet policies and agreements, including but not limited to the Master Services Agreement, Acceptable Use Policy, and Right of Entry agreements. The most current versions of all policies and agreements will be available on the Policies & Agreements subpage of the City of Anacortes fiber department website.

Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit

* indicates a required field