Wildblue Sign-Up

Contact Name: Contact Number:
Date Called:
Physical Address: City:
Mailing / Billing Address
(if different):
State: Zip Code:
Preferred email address:
Do you have a moment to answer a few questions for us?
1. Will this install be at a: Residence or Business
2. Do you own or rent your home? Own Rent
   2a. If on the Hopi Reservation is this in the Walpi Housing Complex? Yes No
   2b. We must contact Roma or Shaun prior to your install for their approval.
3. Which WildBlue Package would you like to order?
    Value Pak (Download speeds up to 512Kbps, 128Kbps up), 5 email addresses with 100MB storage
    Select Pak (Download speeds up to 1.0Mbps, 200Kbps up), 5 email addresses with 100MB storage
    Pro Pak (Download speeds up to 1.5Mbps, 256Kbps up), 5 email addresses with 100MB storage
4. How many computers do you have that you will be connecting to the internet service?
1 2 3 4+
   4a. If you have more than 1 computer do you need a router? (Router Cost: $79.00) Yes No
   Wired (see 4b) / wireless (see 4c)?

   4b. If wired, what is the distance to the next computer?
   Do you need an Ethernet (NIC) card? (Price: $34.75) Yes No
   For how many computers?
   Additional $100.00 per cable run to additional computers for wired networks

   4c. If wireless, what is the distance to the next computer?
   Do you need a wireless Ethernet (NIC) card? (Price: $34.75) Yes No
   For how many computers?
5. What Windows operating system do you currently have on your computer?
95 (won't work), 98SE, NT4.0, ME,
2000, XP, OS9, OS10.2 or higher required.
6. What is your processor speed? (must be faster than 300 megahertz, same for Macintosh)
(Note: Go to the my computer Icon and do a right click, then click properties. This will provide the information to answer #6 & #7)
7. How much ram do you have? (must be more than 128 mega bytes, same for Macintosh)
8. How much free disk space do you have? (must be more than 100 Mega bytes, same for Macintosh)
9. Do you have an Ethernet card? (NIC card) Yes No (same for Macintosh)
10. Do you have any open USB ports? Yes No
11. Do you have active, up to date Virus Software on your computer? Yes No
If no, go to question 13, if yes what is the name of the software?
12. Do you have active, up to date Spy Ware Software on your computer? Yes No
If no, go to question 13, if yes, what is the name of the software?
13. If customer does not have active, up to date Virus and Spy Ware Software, WildBlue internet service will not work. HTI/LSC can provide the Virus software for $1.00 per month and provide free Spy Ware during installation. If customer does not purchase Virus and Spy Ware Software, they agree to and acknowledge that they will be required to pay the full amount for the equipment and will be bound to a 1 year contract at $49.95, $69.95 or $79.95 per month plus any applicable taxes. WildBlue takes seriously computers infected with viruses and spy ware. Customer acknowledges that they will not be able to connect to the internet via WildBlue if they get or have a virus.
I Acknowledge the above statement.
14. Customer requests HTI/LSC to provide virus software during install. Yes No
15. HTI/LSC will run a virus scan on the computer before beginning the installation. If HTI/LSC finds a virus/viruses on the computer, HTI/LSC will not continue the installation until the customer agrees to allow HTI/LSC to charge $65.00 per hour to remove the virus/viruses. If customer refuses to allow HTI/LSC to remove the virus, customer agrees to be billed and pay in full prior to HTI/LSC personnel leaving the premises for the time spent driving to their location. A fee of $65.00 per hour for driving to customer's location will be assessed. A minimum charge of $65.00 will be assessed.
I Acknowledge the above statement.
16. Can we install the satellite dish on your roof by inserting screws into your shingles? Yes No. (If no, go to 16a.)
   16a. Can we install the satellite dish on the side of your home? Yes No. (If no, go to 16b.)
   16b. Can we install the satellite dish in your yard on a pole mount? Yes No. (If yes, go to 16c, if no, go to 16d.)
   16c. Pole mount installed by HTI/LSC costs an additional $125.00 along with a ground rod that costs $6.00. Pole must be installed within 10' of house or we charge an additional $2.00 per foot for trenching past the 10' maximum. Customer must have utilities located prior to HTI/LSC personnel arriving on site. Failure to do so will result in no installation and a service charge of $65.00. Customer may install own pole at own risk. Pole installation must be as follows, no deviations allowed:
  1. Pole must have inside diameter of 2 inches
  2. Pole must have outside diameter of 2-3/8 inches
  3. Pole must measure at least 8 feet long
  4. Pole must be of schedule 40 galvanized steel pipe
  5. Pole must have at least a 9 inch steel rod installed through the base of the pole to prevent rotation
  6. Pole must be secured with at least 3 bags of quick-setting concrete
  7. Pole must have at least 36 inches below ground and 60 inches above ground
  8. Pole must be able to withstand 300 pounds of pull pressure per attachment point
  9. Pole must be away from overhead power line, electric lights, and power circuits
  10. HTI will not guarantee installation on customer provided pole
  11. Customer is required to pay an additional $19.50 for pole mount adapter to mount satellite to pole, no exceptions.
  12. Ground rod installed by HTI/LSC is required at a charge of $6.00
   16d. Can we install a non-penetrating roof mount on your roof? Yes No (if no, we cannot install your system)
   16e. Non Penetrating roof mount costs $25.00 along with 8 concrete blocks at $1.00 each (total is $33.00 plus applicable taxes).
17. Payment for equipment, first month's internet service and additional items is required in full upon arrival for installation.
Payment may be made by the following: check, cash, money order, AMEX, Visa, MasterCard or Discover Card. If paying by check, a $35.00 returned check fee will be applied for all returned checks. If paying by credit card please provide the following information:
Full Name on Card
Card Number
Expiration Date
3 or 4 letter security number on front or back of card
Address card statement is mailed to including zip code
Monthly recurring internet service fees may be automatically billed to your credit card. Do you give HTI/LSC authorization to do this? Yes No
Date authorization provided
May we ask just a few questions related to your house?
1. Is the exterior of your home: brick, stucco, or siding?
2. Do you have a clear view of the southern sky so that there are no trees or homes obstructing your view?
Yes No
3. Do you currently have coax cabling installed in your home? We would like to remind you that we will be required to run coax cabling on the outside of your home. Yes No
4. Is your home a one or two story house?
5. Is there an accessible attic in your house? Yes No
6. Do you currently have Cable or Satellite Television in your home? Yes No
If so, may I ask whom you have your service with?
7. Could you provide or draw directions to your residence/or place of business, where you want the WildBlue installed and fax to us at 928-527-4959. Yes No
   (Required: Please show major highwy #, intersection(s), mile marker(s) and maybe color of the building(s), etc. Note: Customer can mail it to us at above address.)
8. Are there any questions that you may have that we can assist you with? Here is our contact information in case you think of any additional information you would like to know.
   Our Phone # is 928-522-8428 or, our toll free # 877-522-8428.
   Our address is 5200 E. Cortland Blvd, E200,
   Flagstaff, AZ 86004
   We'll be happy to provide you any other information.

Please note that an adult over the age of 18 must be present at the time of installation.