Brigham.net Residential Services Order Form

Full Name Street Address City St Zip Phone# Email Address Phone Lines? TV Service? How Many TVs INTERNET PHONE TV Which Speed? Brigham.net Residential Service Signup Form 250mb $35.00 1 Line $19.95 2 Lines $39.90 1 - $14.00 - 26 Channels 2 - $23.95 - 36 Channels 3 - $64.00 - 80 Channels 4 - $68.95 - 95 Channels 5 - $93.95 - 131 Channels

By clicking submit you indicate your interest in obtaining internet service from Brigham.net. This is not a binding contract. A contract will be provided from Utopia for your connection @ $30.00 per month and for Brigham.net for the services you have selected. A 1 year commitment is required. Additional taxes and fees will be added to the TV service prices. TV Service will require a Set Top Box Rental for each TV. Phone service prices shown are the prices bundled with Internet. Stand alone Phone service is $44.95

1gig $59.00 10gig $199.00

Please enter the colored text in the box Then click the done button.