Santa Rosa SignUp

First Name *

Last Name *

Date of Birth *

Street Address *

City *

State *

Zip *

Your Fiberhood

Do you rent or own the property? *

Rent

Own

Property Owner Name *

Property Owner Contact Number *

Is your billing address different than your service address? *

Yes

No

Billing Street Address

Billing City

Billing State

Billing Zip

Email ( All correspondence including your service agreement, installation scheduler, and billing information will be sent to this email address. ) *

If you do not have an email, please use [email protected]

Contact Number

Preferred Contact Method *

Phone

Email

Are you an existing Santa Rosa customer? *

Yes

No

Internet Service

Package	Speed	Pre-Registration Price	Everyday Price
Ultimate	1000/100 Mbps	$159.95	$219.95
Premium	250/250 Mbps	$94.95	$114.95
Elite	100/100 Mbps	$79.95	$99.95
Standard	50/50 Mbps	$54.95	$74.95
Economy	25/25 Mbps	$44.95	$64.95

Phone Service

Bill Pay Options & Additional Information

Pay Pre-Registration sign-up fee *

Via PayPal with Credit or Debit Card

By Contacting Santa Rosa at (940) 886-2217

Pay by check

Bill Pay Options *

Email Bill (Auto-Pay/Mail in Payment)

Paperbill and mail in Payment (An additional $2 fee will be charger per month)

Santa Rosa Yard Signs are a great way to increase interest in your area. Would you like to have a sign placed in your yard? *

Yes, Please put a sign in my yard

No, Thanks

Please write in anything that our construction crews need to be aware of in your yard. (Dog Fence, Sprinkler System, etc)

Questions/Comments

Terms and Conditions *

I agree to the Terms and Conditions

PROMO CODE

*Some restrictions apply. Limited supplies. Must be installed before 4/1/2022.

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