Satellite Internet Subscription

Satellite Speed
Internet Subscription Form

Customer Information
Name
Organization
Address
City/State/Zip
Primary Phone
Alternate Phone
Email
Mother's Maiden Name
Customer Type	Residential Business Governmental

Select a Service Plan
	Value Pak $49.95/mo. Download 512Kbps, Upload 128Kbps, 5 email addresses, 10MB web space
	Select Pak $69.96/mo. Download 1 Mbps, Upload 200Kbps, 5 email addresses, 10MB web space
	Pro Pak $79.95/mo. Download 1.5Mbps, Upload 256Kbps, 10 email addresses, 20MB web space

Required Equipment and Installation
	Standard Customer Premise Equipment Cost - $299.00
	Standard Installation - $179.95
Your installation may require material and labor in addition to those included in the Standard packages. A free site evaluation may be required to detail specifics of installation

Payment Information

You will be charged for the Equipment and Installation at the time of installation. The Service Plan fee will be billed monthly by WildBlue.

You may choose Credit Card or Direct Deposit. Our representative will contact you to set up your payment method.

Insert Security Code:

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Dakota 2000, Inc.
207 E. Missouri Avenue
Pierre, SD 57501

Ph: 605-945-1427
Toll Free: 800-747-6427
Fax: 605-945-2200