Service Signup Form

Thank you for your interest in high speed internet services provided by Jest Technologies. Please fill out the form below. To begin service, drop off your first payment at your apartment leasing office or mail it to:

Jest Technologies
P.O. Box 2392
Bloomington, IN 47402

First Name:
Last Name:
Service Address:
Permanent Address:
Phone Number:
E-mail:
Questions:
Terms:	Broadband internet service will be provided to the above residence on a month-to-month basis through through the completion of your lease. To reduce the costs of providing the service, you will not be billed. By signing this agreement you agree to make monthly payments to continue your service. Ten days notice must be given to discontinue service without incurring a penalty. Monthly payments are due and payable on the first of each month in the amount of $30. Service will be disconnected if payment is not received by the fifth of the month. The charge to reconnect disconnected service is $15.00. Monthly payments must be made by personal check or money order. Dishonored checks are subject to a $20 delinquency fee. Jest Technologies reserves the right to require payment by money order following receipt of a dishonored check. Payments can be made at your apartment leasing office or mailed to: Jest Technologies P.O. Box 2392 Bloomington, IN 47402 For Service and Technical support you may contact the Jest Technologies Network Help Desk at 812.330.7136 or by simply filling out the online repair request form. Service hours M-F 8am - 8pm Sat/Sun 8am - 4pm Signed and agreed (By Entering your Full Name and Typing "AGREED" you are agreeing to the above stated terms and conditions):
Please Type Your Full Name:
Please Type: "Agreed"

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Service Signup Form