CUSTOMER Subscription Form

- Bush and Corporate Clients -

LINE 1 | Information

Location (Line1)

Custom Location description

Package (Line1)

Preferred Account Name

Alternative Internet Package Description

LINE 2 | Information

Location (Line2)

Custom Location description

Package (Line2)

Preferred Account Name

Alternative Internet Package Description

LINE 3 | Information

Location

Custom Location description

Package (Line3)

Preferred Account Name

Alternative Internet Package Description

LINE 4 | Information

Location (Line4)

Custom Location description

Package (Line4)

Preferred Account Name

Alternative Internet Package Description

LINE 5 | Information

Location (Line5)

Custom Location description

Package (Line5)

Preferred Account Name

Alternative Internet Package Description

LINE 6 | Information

Location (Line6)

Custom Location description

Package (Line6)

Preferred Account Name

Alternative Internet Package Description

LINE 7 | Information

Location (Line7)

Custom Location description

Package (Line7)

Preferred Account Name

Alternative Internet Package Description

LINE 8 | Information

Location (Line8)

Custom Location description

Package (Line8)

Preferred Account Name

Alternative Internet Package Description

LINE 9 | Information

Location (Line9)

Custom Location description

Package (Line9)

Preferred Account Name

Alternative Internet Package Description

LINE 10 | Information

Location (Line10)

Custom Location description

Package (Line10)

Preferred Account Name

Alternative Internet Package Description

Billing Cycle

MONTHLY - Payment due before service period, disconnection if payment not received by the 7th of the month of service

QUARTERLY - Payment due before service, disconnection if payment not received by the 10th of the first month of service

YEARLY - Payment before service and get 1 month FREE

OTHER APPROVED BILLING CYCLE

Approved Billing Cycle Description

Additional Information

Comment / Request / Special Instruction (optional)

Click here to indicate that you have read and agree to the terms of the Blink Customer Agreement and that all the above information provided is accurate.

CUSTOMER Subscription Form

Company Information

LINE 1 | Information

LINE 2 | Information

LINE 3 | Information

LINE 4 | Information

LINE 5 | Information

LINE 6 | Information

LINE 7 | Information

LINE 8 | Information

LINE 9 | Information

LINE 10 | Information

Billing Cycle

Additional Information