Self Care Test Page 2 | Santel Communications

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Service Connect

Plan: {querystring:plan}

Whole Home Wi-Fi: {querystring:whw_addon}

Additional Extenders: {querystring:extenders_qty}

YardLink: {querystring:yardlink}

Estimated Monthly Total: ${querystring:subtotal}

We’ll call to finalize install details (usually same or next business day).

Name(Required)

First Last

Social Security Number(Required)

Birth Date(Required)

Phone(Required)

Allow Text to Contact Number?(Required)

Yes

No

Email(Required)

Mailing Address (City, State, Zip)(Required)

Service Address (City, State, Zip)(Required)

Residence Status(Required)

Owned

Rented

Land Lord - Name & Contact Info

Other Authorized Persons

Name

Relationship

Phone

Authorization for our team to speak with someone other than the applicant.

AutoPay(Required)

Yes

No

AutoPay Date

5th of Each Month

20th of Each Month

CPNI Opt-Out(Required)

Yes

No

Opt-out means we will not share account info for marketing beyond what’s required to provide your service.

Wi-Fi Network Name (SSID)

Wi-Fi Password

Security Question (Pick One)(Required)

Security Question Answer(Required)