Business Service Application 1Business Applicant Info2Location of Service3Payment Options4Business Services5Agreements, Signature, W-9 NameThis field is for validation purposes and should be left unchanged.Business Applicant InfoBusiness Name(Required)Employer Identification Number(Required)Billing Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Contact Person(Required) First Last Work Phone(Required)Authorized Contact MethodCell Phone(Required)Authorized Contact MethodEmail Address(Required) CPNI Security Password(Required)This is a password of your choosing that will be required to verify your account when calling in to RTC Networks.List authorized individuals who can access or make changes to the account. (CPNI Password is required when calling RTC.)ListNameCell #Email Address Add RemoveList name and phone number of employee(s) on site: Location of ServiceCountyPrevious Occupant911 Physical AddressCityIs your location within city limits? Yes No TownshipSectionRangeLatitudeLongitudeHave you had RTC service before? Yes No Previous #/name on account(Required) Payment OptionsWould you like to sign up for SmartHub (online payment portal)? Yes No Email Address(Required) Would you like to go paperless? Yes No Would you like to be on an automatic payment plan? Yes No Type of account for automatic payments?(Required) Checking Savings Upload Voided Check(Required)Must attach a voided check to complete. Drop files here or Select files Max. file size: 100 MB, Max. files: 1. Upload Deposit Slip(Required)Must attach a deposit slip to complete. Drop files here or Select files Max. file size: 100 MB, Max. files: 1. Name(Required) First Last Cell Phone(Required)Name of Financial Institution(Required)Routing Number(Required)Bank Account Number(Required)Applicant Printed Name (must match name on bank account)(Required)By entering your name, you are effectively providing your signature and authorizing the financial institution to pay your monthly RTC Networks service bill by charging your account for each payment. You agree that each payment shall be the same as if it were an instrument personally signed by you. This authority is in effect until revoked by you in writing or by email, no less than 3 business days prior to the date of the recurring payment. In addition, you have the right to stop payment of a charge by timely notification to RTC Networks no less than 3 business days prior to the date of the recurring payment. If you close or change your account, you will notify RTC Networks. You understand, however, that both the financial institution and RTC Networks reserve the right to terminate this payment plan, or your participation therein. *About 2 months after you sign up, you’ll receive a notice on your RTC Networks statement that says, “Pay by Bank- Do Not Pay.” Until you see that statement, continue to pay your bill using your current method. Payments will be deducted the 15th of each month or the first business day thereafter.Would you like to enable pay by phone?RTC Secure Payment #: (855) 940-3817. Yes No Secure Pay Pin(Required)Pin required when you call RTC Secure Payment #.Please enter a number from 0000 to 9999.Is the business federal excise tax exempt? Yes No Exempt #(Required)(attach documentation via upload link at end of application)Is the business sales tax exempt? Yes No Exempt #(Required)(attach documentation via upload link at end of application) Business ServicesNote: myRTCtv requires RTC Networks internet serviceSelect Services(Required) Broadband Internet Phone myRTCtv You must also select Broadband Internet to see TV packages/options. Internet service from RTC Networks is required for TV service.BroadbandBroadband Internet (Unlimited Data Usage)Choose a package. $30 activation (Speeds are up to the listed speed and may be limited in some areas.) *Pricing does not include fees and taxes. View Business Broadband Facts Labels The Enterprise Solution - 10 Gig x 10 Gig (10,000 Mbps) $500 per month The Trail Blazer Plan - 5 Gig x 5 Gig (5,000 Mbps) $250 per month The Business Power Plan - 1 Gig x 1 Gig (1,000 Mbps) $150 per month The Growth Starter Plan - 500 Mbps x 500 Mbps $100 per month Wi-Fi Basic Wi-Fi $5 per month None. I will self install my own Wi-Fi equipment. Wi-Fi Password(Required)Minimum of 8 characters, 1 number and 1 capital letter.SMARTBIZ and myRTCnetPro (Included with Internet for qualifying small-medium businesses)RTC Networks meets the needs of small to medium businesses with an all-in-one managed service that increases staff productivity, secures critical business systems, and drives customer loyalty. Yes, I am interested in SmartBiz Not at this time SmartBiz FeaturesCheck the boxes of the features below that interest you. Learn more about SmartBiz. Dedicated primary, POS, staff & customer networks Mesh Wi-Fi integration Network security and firewall Internet traffic policy by network Business-branded customer Wi-Fi portal Network resilience Analytics & insights myRTCnetPro App (App to control all of the above) Static IP ($7 per month) Yes No PhoneBasic Business PhoneApproximately $33 per month + $30 activation - Unlimited Long Distance Included (does not include international calling) Yes No This field is hidden when viewing the formSection BreakPhone FeaturesAdditional calling features available Call Waiting - $1 per month Three-way Calling - $1 per month Caller ID - $4 per month Call Forwarding - $1 per month Voicemail (See Options) Voicemail Options Gold ($5 per month) Silver ($4 per month) Bronze ($3 per month) Number of Phone Lines NeededNumber of Fax Lines NeededAre you interested in a phone system? Yes No Long Distance NDLD Flat Rate (14¢ per minute in-state, 8¢ minute state-to state) NDLD Nationwide (10¢ per minute, $4.95 per month) No Long Distance Would you like a PIC freeze? Yes No Would you like your phone # listed in the directory? Yes No List as:Would you like an additional listing?$1 per month per additional listing Yes No List as:If no: Non-listed 50¢ per month (# available on caller ID display & thru information) Non-published $1 per month (# not available anywhere) International call blocking is automatically added at no charge. If you do not want the block check here. Remove Block myRTCtvmyRTCtvChoose a package. Lite - $58.59 per month Expanded - $131.81 per month Platinum - $143.59 per month If you sign up for the Lite, Expanded, or Platinum package, you can also sign up for any or all of the following packages.Premium PackagesPremium channels included in Absolutely Everything package HBO - $18.95 per month Cinemax - $15.95 per month Starz & Encoure - $15.95 per month NFL Red Zone - $55.00 per NFL Season Paramount+ with Showtime - $15.95 per month StreamsAll packages include 1 free stream, $2.50 per month for each for additional. 6 included streams - Free Additional stream 1 - $2.50 per month Additional stream 2 - $2.50 per month Additional stream 3 - $2.50 per month Additional stream 4 - $2.50 per month Additional stream 5 - $2.50 per month DVR Hours - maximum of 300 hoursAll packages include 100 DVR hours, $5 per month for each for additional / Absolutely Everything package includes 300 DVR hours 100 DVR hours - Free Additional 100 DVR hours (total 200) - $5 per month Additional 200 DVR hours (total 300) - $10 per month Set-top boxLease Lease - $5 per month each Want additional boxes?Enter #Installation RTC Networks Assisted Installation - $50 Self Installation - Free Comments Agreements & SignatureHigh Speed Broadband Internet Agreement(Required)By signing this application, Customer agrees to the following. High Speed Internet service activation includes a single home run wire to a designated point for handoff to a residential gateway and RTC Networks' Technicians will verify internet connectivity. Any additional work done at the customer's request (including, but not limited to, moving existing jacks or installing new jacks) will be billed at RTC Networks prevailing hourly rate plus materials.RTC Networks offers 1 residential gateway for lease as part of the package. Residential gateways, power supplies, and cords remain the property of RTC Networks, and in some cases, may need to be returned when service is disconnected. Equipment that is not returned within 5 days after disconnection will be billed to the Customer at reasonable retail rates.RTC Networks provides this service for the purpose of direct access to the Internet. This is not a wholesale service therefore it cannot be resold by the customer. Please read RTC Networks' Acceptable Use Policy. Violation of the policy may jeopardize your service. I have read and understand the above information and authorize RTC Networks to install high speed internet service. I am at least 18 years of age and the name on the account where the service will be installed matches the name above. Agreement is nontransferable.Operation Round Up(Required)All RTC Networks customers are automatically enrolled in our Operation Round Up program, a community-service fundraising initiative. Under this program, your bill will be rounded up to the nearest dollar, and 100% of the additional funds will be awarded to qualifying local community projects based on applications from our members. If you prefer not to participate, please contact us and we will remove you from the program. I have read the text aboveEquipment Agreement(Required)Delivery, Use, Care, Replacement Services, Right of Entry By signing this application, you agree that any equipment delivered and installed at your address as reflected in our business records, is for personal use at said address. You agree not to remove it from the address except to return it to us. You agree to take reasonable care of the equipment and agree not to open the equipment (except change batteries in the remote control), take apart, or to alter it in any way. You are responsible for all damage to the equipment, beyond reasonable wear from normal use, which occurs before you return or surrender it to us. The equipment must be returned in fully usable condition. Except for damage caused by misuse or abuse, if you notify us of equipment failure, we will repair it or exchange it for properly functioning equipment. You agree to allow us to enter your installation address, at any reasonable time, to inspect, repair, replace, or remove the equipment. Payment for use of service and failure to comply with agreement Your use of the equipment and services you receive are subject to the various policies of RTC. Such policies and practices are subject to change. Monthly fees for use of the equipment are billed in advance. If you fail to comply with your commitments contained herein, or with any term of the agreement under which you are receiving services from us, you understand and agree we may do any combination of one or more of the following: 1.) terminate your right to use of the equipment; 2.) terminate your right to receive services from us; 3.) recover the equipment; 4.) bring legal or other action for return of the equipment and any amounts due to us hereunder, together with liquidated damages for failure to return the equipment as required herein. If you choose to stop using the equipment: You may terminate your use of the equipment by contacting customer service. When you do so, or if we terminate your right to use the equipment as described above, we will ask you to return the equipment. All rental payments and additional charges will be due to us at this time. You agree to cooperate and make yourself available to return the equipment to us. Equipment not returned upon disconnect is billable. Liquidated damages for failure to return equipment If you fail to timely return the equipment to us in accordance with your commitment herein, you understand and agree that the costs and damages we will incur are not readily ascertainable and are difficult to predict or calculate at the time. You agree that a reasonable estimate of our damages is the replacement cost for the equipment and power cord(s), plus the costs associated with our attempts to recover the equipment from you. Again, when you are required to return the equipment to us, we appreciate in advance your cooperation in making sure the equipment is promptly returned. *All materials and labor inside premise will be billable above and beyond the activation charge. Note: An incomplete application may delay installation of services. I agree to the equipment agreementService Application Consent(Required) I (We) hereby apply for phone/internet/tv service from RTC, with the understanding that I (We) am (are) fully responsible for payment of the account. I (We) further agree that RTC can apply any accumulated capital credits to the account if the account becomes delinquent. Furthermore, by signing this service agreement, I(We) hereby agree to abide by the rules, regulations and by-laws of the cooperative, which can be found on our website, or by calling the RTC office, and, if applicable, the equipment and internet agreements outlined above. By entering your initials on the line below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge.Business Applicant Printed NameUpload ID(Required)Please submit a copy or photo of a valid ID. Drop files here or Select files Max. file size: 100 MB, Max. files: 1. Statement of Non-Discrimination This institution is an equal opportunity provider and employer. Payment Options Brochure (PDF) Power Backup Disclosure (PDF)W-9Request for Taxpayer Identification Number & Certification As a cooperative member-owner, a W-9 is required to pay out Capital Credits. If a joint account, both members must complete a W-9. Upload a copy here or fill in the information below.Upload W-9Download a copy from the IRS: W-9 Form to complete and then upload here. Drop files here or Select files Max. file size: 100 MB, Max. files: 2. Complete W9 Online W-9 Form & General InstructionsName(as shown on your income tax return)Business Name(if different from above)Choose the appropriate federal tax classification of the person whose name is entered. Individual/sole proprietor or single-member LLC C Corporation S Corporation Partnership Trust/estate Limited Liability Company Other Enter the tax classification(C=C corporation, S=S corporation, P=Partnership)Other(see instructions)Street Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3)Exempt payee code (if any)Exemption from FATCA reporting code (if any)Taxpayer Indentification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later. Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter.Social Security Number or Employer Identification NumberCheck which applies to you. Social Security Number Employer Identification Number Social Security NumberEmployer Identification NumberConsent1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. I am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later. Under penalties of perjury, I certify that:Signature of U.S. Person (Full Name)By entering your name on the line, you are effectively providing your signature.Untitled First Choice Second Choice Third Choice Having trouble completing the online application? A paper application (PDF) is also available.
