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Service Order

This form serves as the official RiverStreet Service Order request and authorization for installation and account setup. All information provided below will be collected by an authorized RiverStreet representative to establish service and verify account eligibility.

Sales Representative Information

This section is for RiverStreet Sales Representatives only. Please enter your full name and include any relevant notes about the customer interaction (e.g., customer preferences, property details, follow-up needs, etc.).
This section is for RiverStreet Sales Representatives only.
MM slash DD slash YYYY

Customer Information

Please enter the customer’s information exactly as it should appear on the account. Verify spelling, service address, and contact details before submitting.
Customer Name(Required)
*Customer’s name should match the name on their ID.
Customer's Physical Street Address (Service Address)(Required)
Is the mailing address the same as the physical address?(Required)
Customer's Mailing Address (if different than service address)
Do you want to receive text alerts?(Required)
Standard messaging and data rates apply. Opt-out by replying STOP.

Password Verification

This 4-Digit PIN will be used for authentication purposes. For account verification, you will be required to provide your 4-Digit PIN verification when inquiring about the account. The PIN request will be asked for all inquiries and changes to the account. Only authorized parties has access to the PIN on the account.
Secret Question #1 (select one)(Required)
Secret Question #2 (select one)(Required)
Secret Question #3 (select one)(Required)

Internet Service

Please record the Internet plan and any promotional offers accepted by the customer. Ensure selections are accurate and authorized prior to submission.
OPTi-Fi Fiber Internet Speed Requested by Customer.(Required)
$5 monthly recovery fee applies. Prices do not include taxes, surcharges, or additional fees.
Service Terms:(Required)
RiverStreet services are offered with no contract unless a promotional offer is chosen. Accepting a promotional offer activates a 12-month service commitment. If the commitment is not met, a fee of up to $399 or the full value of the promotional credit may be charged.
Customers who do not accept a promotional offer remain on standard month-to-month terms with no commitment required.
Prices exclude taxes, surcharges, and additional fees.
Promotional Offer Acceptance(Required)
*Promotional offers require a one-year service agreement. Confirm customer understanding before submitting.

Wireless Router

A standard wireless router is included at no extra charge with all Fiber Internet plans. For Copper plans, a $4.99/month router fee applies. Installation is free during the initial service setup. A $65 installation fee applies if installation is requested after the initial setup. If the router is not returned upon service termination, a minimum charge of $125 will be assessed.
Does the customer wish to have a wireless router installed at initial setup?(Required)
Wireless Extenders – available upon request. A one-time setup fee up to $100 will be charged and a $10 monthly fee for each extender.(Required)
Wireguard Protection | Monthly Cost: $5(Required)
This agreement covers: Repairs or replacement of faulty standard inside wiring, modular jacks, and defective modem or router due to normal wear and tear. Service charges for issues related to standard inside wiring or modular jacks. The plan does not cover customer-provided equipment or the installation of additional jacks. Certain restrictions apply.

Phone Service

Plan Cost: $30 per month. All phone plans are VOiP lines. You may port an existing phone number or get an assigned number from RiverStreet. Package includes unlimited long distance and 10 calling features.
Would the customer like to add phone service?(Required)
Do you wish to port your existing phone number?(Required)
If yes, a RiverStreet representative will contact you for additional information. *DO NOT MAKE ANY CHANGES AT THIS TIME WITH THE CURRENT PROVIDER.

Payment Information

By signing up for service, you acknowledge that you have reviewed and understand the payment terms below.
Payment is due on the 26th of each month. Accepted payment methods include Cash, Check, eCheck, Credit Card, Debit Card, Bank Transfer, and the Online Bill Portal.(Required)

Online RiverStreet "My Account" Access Setup

You may submit trouble tickets, view your account or pay your bill using the Online Web account. A username name and password must be established to access the online portal.

Service Agreement

TERMS OF SERVICE – The applicant hereby grants unto Wilkes Telephone Membership Corporation and all of its Subsidiaries, its successors and assignees, the perpetual right, privilege and easement to go in and upon the above listed property to install, construct, operate and maintain communications and utilities facilities, equipment, cables and lines on or under the above-described lands and/or upon or under all streets, roads or highways abutting said land.
Clear Signature
I have read and understand the Service Agreement described above and grant Wilkes Telephone Membership Corporation the right to install and maintain facilities as stated. By signing this Statement of Service agreement, the Client agrees to the terms and conditions outlined above. The Client acknowledges their understanding of the service commitment and the potential charges associated with the promotional credit, if accepted.
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