Residential Services Application

Name*

First Last

Current Address*

Street Address Address Line 2 City State ZIP Code

NEW Address (provide if moving)

Street Address Address Line 2 City

Email*

Cell Phone Number*

Alternative Phone

Customer Status*

Current Jefferson Telecom Customer
New Jefferson Telecom Customer

Preferred Date for New Service - (Service can typically be installed within 2-3 days of requested date)

Residential Fiber Internet

Internet service includes 5 e-mail addresses, 24/7 technical support at 515-386-5500, multiple computer access, NO contract to sign, and unlimited usage with NO DATA CAPS.

Social: 100 Mbps / 10 Mbps = $69.95
- Bundled price is add'l $10/month for 100 Mbps
Family: 200 Mbps / 20 Mbps = $89.95
- Bundled price is add'l $30/month for 200 Mbps
Power: 500 Mbps / 50 Mbps = $129.95
- Bundled price is add'l $70/month for 500 Mbps
Gigabit: up to 940 Mbps / 100 Mbps = $199.95
- Bundled price is add'l $140/month for a Gigabit connection

Wi-Fi Management

Professional installation of an eero, replacing your router, plus connectivity of wireless devices and free local technical support

$9.95/month

Tech Home Security & Anti-Virus Protection

Web security and anti-virus protection against the latest online threats. Plus, sync and back up all of your files, photos, contacts and important information.

Protect: Covers 1 desktop + 1 mobile device = $7.95/month
Protect Plus: Covers 4 devices = $12.95/month
Support: Covers 4 devices + unlimited premium technical support = $15.95/month

Television Service

The ultimate viewing experience with high definition channels with ALL packages, whole home cloud DVR, and innovative features.

Local Plus Package (35+ Channels) = $65.95
Family Package (85+ Channels) = $130.95
- Entertainment Pack (add on to Family Package, add'l 25+ Channels) = $13.00
- Variety Pack (must subscribe to Entertainment Pack, add'l 8 Channels) = $8.00

Premium Movies

Pick One: HBO, Cinemax, Starz Super Pak, or Showtime = $29.95/month. Each additional movie group = $10.00.

HBO
Cinemax
Starz Super Pak
Showtime

NFL RedZone Season Pass

NFL RedZone captures every touchdown from every game on Sunday afternoons plus original sports programming.

$49.95

Additional Cloud DVR Storage

IMPORTANT INFORMATION: All TV's require a box to receive programming. Jefferson Telecom provides 2 FREE "leased" boxes. Additional boxes are $9.95/month. Jefferson Telecom provides each account with 1 Stream 50 GB Cloud DVR (15 Hrs. HD) for FREE.

250 GB: 3 Streams (100 Hrs. HD) = $9.95/month
500 GB: 5 Streams (200 Hrs. HD) = $14.95/month
1000 GB: 10 Streams (400 Hrs. HD) = $19.95/month

Telephone Service

Residential Telephone Service = $28.50
Business Telephone Service = $35.50

Long Distance

Choose from two flat-rate plans for your long distance needs.

$.16 per minute with a $3.95/monthly charge
$.20 per minute with NO monthly charge
I do not want long distance through Jefferson Telecom

Calling Features

Enjoy our most popular calling features. Additional calling features are available.

Basic Caller ID = $5.50
Caller ID/Call Waiting ID = $8.25
Voice Mail = $4.95
Voice Mail to Email = $5.95
Call Forwarding = $1.75
Call Waiting = $1.75
3-Way Calling = $1.75

Wire Maintenance

Covers repairing existing landline, Internet, and TV wiring at no charge.

$2.95/month

Bundles

Bundling your services costs less than buying these services separately from different companies. Plus you'll get one monthy bill, local support, and no contract to sign.

Triple Play DELUXE (Residential Phone Line, 6 FREE Calling Features, 50 Mbps Internet, Family Package TV) - $174.95
Triple Play LOCAL (Residential Phone Line, 6 FREE Calling Features, 50 Mbps Internet, Local Plus Package TV) - $129.95
Double Play TV DELUXE (Residential Phone Line, 6 FREE Calling Features, Family Package TV) - $134.95
Double Play TV LOCAL (Residential Phone Line, 6 FREE Calling Features, Local Plus TV) - $89.95
Double Play NET (Residential Phone Line, 6 FREE Calling Features, and 50 Mbps Internet) - $69.95

U.S. Cellular Authorized Agent

Jefferson Telecom has been an authorized agent for U.S. Cellular for over 30 years. Our staff can help you determine the best calling plans and phones to fit your needs and budget.

Please contact me to discuss my cellular needs.

Additional Comments or Questions

Preferred Form of Contact

In order to start service, a Jefferson Telecom staff member will need to contact you to verify your information. At that time, we will verify all pricing and services requested. Please mark your preferred contact method. Thank you for your inquiry!

Email
Cell Phone - Call
Cell Phone - Text
Alternative Number

Residential Services Application

Jefferson Telecom Service Application