Fiber Internet Service Application (Residential) PIE&G Residential Internet Service Application 1Fiber Internet Service Application2Hold Harmless & Working Agreement3Right of Way Agreement4Broadband Service Order And Agreement5Property Map First Name(Required)Last Name(Required)Email(Required) Phone(Required)How did you hear about PIE&G Connect?Thank you for applying for a fiber internet service connection. We look forward to providing you with great internet service! Please note there is a one-time $100 fee that is due with this application. There will be no additional costs charged to install fiber services to your home or business. We are offering four different internet speeds to choose from as indicated below. Please pick one of the speeds below by checking the box in front of the service description:(Required) 100 Mbps - $64.95 per month (A $5/month autopay discount is available) 250 Mbps - $79.95 per month (A $5/month autopay discount is available) 500 Mbps - $89.95 per month (A $5/month autopay discount is available) 1 Gbps - $99.95 per month (A $5/month autopay discount is available) View detail information about our Available Internet PackagesAs part of the terms and conditions I understand a Smarthub account is required to receive paperless bills. By checking the box below, I certify that I have an active Smarthub account:(Required) I have an active Smarthub account to receive paperless bills. We are now also providing VOIP (voice over internet). Please indicate below if you are interested in being contacted about our VOIP services:(Required) Yes, please contact me about VOIP service No, I am not interested in VOIP service. I agree to pay the $100 Consent(Required) I agree to pay the $100 one-time application fee and certify that I have an active SmartHub account.(Required)Terms of Service Consent(Required) I also agree to the terms of service.(Required)ApplicantCo-Applicant (if applicable) For joint accounts, both signatures are required to process an application.Signature(Required)For joint accounts, both signatures are required to process an application.SignatureFor joint accounts, both signatures are required to process an application.Name(Required)NameDate(Required) MM slash DD slash YYYY Date MM slash DD slash YYYY I (We),Name(Required)hereby attest that I (we) have legal title to the real property for which this application is made. I (We) authorize Presque Isle Electric & Gas Co-op (PIE&G) to install an fiber optic internet service line on the property located atLocation(Required)in the township/village ofTownship/Village(Required)I (We) further agree to all PIE&G terms and conditions, billing rules, policies and regulations governing fiber internet service. To allow for proper installation of infrastructure to obtain services, I (we) agree to mark and expose all equipment buried underground on my property, including but not limited to the following: Water Lines and Wells Septic Tanks and Drain Fields Electric or Water Lines Between Buildings Tanks or Containers that Contain Flammable Material Gas Lines Between Buildings Satellite TV, Dish Antennas, Sprinkler Systems Pet Fences and other underground equipment. I (we) agree that in in the process of installation of service lines, PIE&G will rely on my markings and/ or flags indicating the location routes for all underground equipment on my property. If my location routes are incorrectly marked or omitted, resulting in damage to my equipment, I agree to hold harmless PIE&G and its employees for such damage and understand that repairs or replacement of such equipment will be at my own expense. Property Owner Initials(Required)Property Co-Owner InitialsPIE&G employees will exercise reasonable care while performing such work and will clean up when the work is complete. I (We) agree that I will not hold PIE&G or its employees responsible for the condition of the driveway or property after the work is completed.ApplicantCo-Applicant (if applicable)Signature(Required)For joint accounts, both signatures are required to process an application.SignatureFor joint accounts, both signatures are required to process an application.Date(Required) MM slash DD slash YYYY Date MM slash DD slash YYYY Property Owner’s Name(s)(Required)Property Address(Required)Mailing Address I/we as property owner(s), do hereby grant permission for Presque Isle Electric & Gas Co-op to construct and maintain a fiber optic internet service line and related attachments on my/our property. I further understand that if necessary, I may be contacted to provide a signed easement for right of way. The signature(s) on this form certify that I/we are the owner(s) of record of this property and have full authority to grant this request. ApplicantCo-Applicant (if applicable)Signature(Required)For joint accounts, both signatures are required to process an application.SignatureFor joint accounts, both signatures are required to process an application.Date(Required) MM slash DD slash YYYY Date MM slash DD slash YYYY I HAVE READ, UNDERSTAND, AND AGREE TO BE BOUND BY THE “BROADBAND SERVICE ORDER TERMS AND CONDITIONS,” WHICH CAN BE FOUND AT www.piegconnect.com. I HAVE READ, UNDERSTAND, AND AGREE TO THE “ACCEPTABLE USE POLICY,” THE “PRIVACY POLICY,” THE “INTERNET TRANSPARENCY POLICY,” AND THE “COPYRIGHT INFRINGEMENT POLICY” WHICH CAN BE FOUND AT www.piegconnect.com. I UNDERSTAND THAT VARIOUS POLICIES REQUIRED FOR USE MAY BE ADDED OR AMENDED. PRESQUE ISLE ELECTRIC & GAS OR PIE&G CONNECT WILL NOTIFY ME VIA EMAIL OF ANY CHANGES OR ADDITIONS TO POLICIES REQUIRED FOR USE. I AGREE TO BE BOUND BY ALL ADDED OR AMENDED POLICIES AFTER I HAVE RECEIVED NOTIFICATION. ALL POLICIES CAN BE FOUND AT www.piegconnect.com. I UNDERSTAND THE SERVICES REQUIRE ACTIVE ELECTRIC SERVICE AT MY LOCATION, AND IF AN ELECTRICAL SERVICE OUTAGE OCCURS, THE SERVICES, INCLUDING ALL VOICE SERVICES, IF ELECTED, MAY NOT FUNCTION.ApplicantCo-Applicant (if applicable)THIS IS AN IMPORTANT CONTRACT DOCUMENT. DO NOT SIGN AND RETURN SUBMIT UNLESS YOU HAVE READ, UNDERSTAND AND AGREE TO THE “BROADBAND SERVICE ORDER AND AGREEMENT GENERAL TERMS AND CONDITIONS”.Signature(Required)For joint accounts, both signatures are required to process an application.SignatureFor joint accounts, both signatures are required to process an application.Date(Required) MM slash DD slash YYYY Date MM slash DD slash YYYY PIE&G Connect strongly recommends uploading a property map to identify where equipment is buried before we install fiber optic cable to your property.(Required) I agree to upload a property map and identify where equipment is buried before PIE&G Connect installs fiber optic cable to my property. I am choosing not to upload a property map to identify where equipment is buried on my property and have agreed to accept all responsibility. Upload a PDF or JPG of your property map.(Required) Drop files here or Select files Accepted file types: jpg, png, pdf, Max. file size: 128 MB, Max. files: 2. For instructions and an example of completing a property map, click here.
