Application for Atlas Residential Internet service
Name *
City *
Service Address *
Mailing Address *
Phone number *
6 Month Term Option 
I agree to maintain the DSL Access Service line/or Broadband Service for a period of 6 months following installation. If service is disconnected for any reason prior to 6-month commitment period, the customer will be billed an early termination fee of $25.00. If DSL Access Service line/or Broadband Service is temporally suspended for nonpayment by the customer, a fee of $25.00 will be applied to restart service
 *
I agree to the one time $95 install fee for all new customers.
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Service Plan Options
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Purchase Smart Router
Click this option you you would like to purchase a Smart router from Atlas for $175+ tax
 *
Applicant's signature to agree to service *
In making this application the undersigned agrees to the Rules of the Company, and to any general changes in the Rules, or Rates for the service furnished under this application. The application becomes a Contract when accepted in writing by the Company. Applicants agrees he will be responsible for the equipment located at the customer’s premise. Applicant agrees that should they become delinquent in their account and it becomes necessary that the company refer the account to an attorney for collection, that they will pay attorney’s fees as follows: 25% for collection without litigation, 33% if litigation is necessary. *
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