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BY SIGNING THIS FORM, YOU REPRESENT THAT YOU ARE OF LEGAL AGE TO ENTER INTO THIS AGREEMENT AND THAT YOU HAVE READ AND UNDERSTAND FULLY THE TERMS AND CONDITIONS OF THIS AGREEMENT.

IT Works LLC  
111 East Division Street, Amboy, IL

815.200.4799

wwww.itworkssupport.com

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Install Fee (Non Refundable once the installation has begun) - $125.00 ___ Customer Initial

Monthly Internet Packages

Total (Install + 1st Month) ____________

Customer Printed Name ________________________________________________

Customer Email Address ________________________________________________

Customer Service Address _______________________________________________

Customer Phone _______________________________________________

Customer Signature _______________________________   Date: ______________

IT Works LLC  
111 East Division Street, Amboy, IL

815.200.4799

wwww.itworkssupport.com