PRIS -BroadBand Services Sign-Up

This Application for PRiS BroadBand Services is supplemental to a regular PRiS Application Form, and must be completed together with the regular "PRiS Membership Application", and the "Agreement for Use of BroadBand Services".

I, (name)____________________________, have carefully reviewed all aspects of the "Agreement for Use of BroadBand Services", and hereby request the provision of PRiS Broadband Services at the location shown below, under the terms of that Agreement.
I note that:

PRiS makes no warrantee about the the quality or speed of the Internet connection that BroadBand services provide.
PRiS will continue to allow me to use Dial-up connectivity as well as my Broadband Internet connection, but I will ensure that both connections are not used simultaneously at any time. Simultaneous data transfer on both connections will lock up my account until PRiS staff release the account.
I understand that the portion of the Acceptable Use Policy relating to the PRiS Data Transfer Limit Policy applies to PRiS Broadband Services. I understand that, if PRiS elects to apply these charges to my account, my likelihood of incurring such charges increases with BroadBand access, and that this connection has the capability to transfer very large amounts of data if used without due caution. I understand that charges for data transfer are determined strictly on a cost recovery basis, and are currently $10/GB for data in excess of 6 GigaBytes/month.
I understand that, if I elect to use PRiS equipment at my location, I must accept responsibility for this equipment, as stated in the Agreement.
I understand that the potential for intrusion by outside sources of my computer increases with an 'Always On' connection. I will verify that 'File Sharing' settings are appropriate. I understand the value of firewall software in the avoidance of unauthorized intrusion.
I understand that, as with all Internet communications, sensitive information should be secured with VPN or other encryption protocols.

Name:

PRiS UserId:

Phone:

Address of Equipment Installation:

Type of Connectivity

	A) Wireless with PRiS Equipment	$40/month		A) ADSL with PRiS Equipment	$33.99/month
	B) Wireless with Own Equipment	$30/month		B) ADSL with Own Equipment	$33.99/month

Please fill in the following information ONLY if you have selected Option A (above)

I hereby authorize PRiS to verify with certain credit agencies and banks, the validity of my credit rating.
Member Signature:______________________________________ Date:______________

Principal Banking Institution:_________________________________(Acct #)______________________
PRiS Equipment must be secured by one of the following methods:
1) If you own the property at which the equipment will be installed,
..... Attach copy of most recent Tax Assessment. (Legal Description or Assessment Notice No:___________)
2) If you are applying for an account for a Company Incorportated in the Province of British Columbia,
..... Attach copy of Certificate of Incorporation. (Incorporation Number:__________________, Date:____________.)
3) A signed Charge Card Debit Memo*
..... Card Number__________________________________Exp____/____.Authorization Number________________.
..... (Will not be deposited, except in case of default on Agreement)
4) A cash / cheque deposit with PRiS*
..... Deposit Received: Signature of PRiS Representative:________________________.
*$100.00 for ADSL, $480.00 for Wireless **Security required will decrease by $120.00 per year

Office Use Only
Security:(Circle One) [ OOR or Verified ] ........Office Signature:____________________, Date__________.

Office Use Only
UserName:_____________ Account Number:________ MAC Address:_____________________ IP Address:____________ Access Point:_____________ Polarity,Channel:[V|H] ____ Material Supplied:________________________ Service Start Date: