ClearwireAuthorized Representative - Central Systems Boise Eagle Meridian Nampa Kuna Caldwell Idaho

Get Connected to Clearwire at A4Wireless.com Boise Eagle Meridian Nampa Caldwell Kuna Mountain Home Emmett Middleton Idaho Washington Oregon California Texas Nevada Florida North Carolina Tennessee Ohio Virginia New York Wisconsin Minnesota Alaska Hawaii
(208) 323-2700 
Modem Registration Form
get connected @ Central Systems . us
High Speed Internet Access Service Providers
 Date:

Get Connected to Clearwire at A4Wireless.com Boise Eagle Meridian Nampa Caldwell Kuna Mountain Home Emmett Middleton Idaho Washington Oregon California Texas Nevada Florida North Carolina Tennessee Ohio Virginia New York Wisconsin Minnesota Alaska Hawaii
(208) 323-2700 

Subscriber Name:  
Address:City:
State: Zip Code:
Phone 1:   Phone 2:

Current Email:  

Social Security # : ENTER "123" - Give Real # verbally over the phone

Date of Birth:     Credit / Debit:

Credit/Debit Card Number:

Exp Date:   Security Code: ENTER "123" - Give Real # verbally over the phone

Name on Credit or Debit Card:

 Card Address:City:State:Zip Code:

Drivers License Number:    State:

Account Name:   Password: (4 to 8 digits)

Secret Word:     

Modem Serial #Plan:

signal:  Referral or Promotion Code: (Impact, dex, radio, who referred you?)

Notes:

Questions:

Directions:

I am aware this Clearwire modem is programmed for Premium 1.5M service and other service plans are available. A2Access allows me to try the service to verify adequate signal is available. If I love it, I keep it and choose which service plan I will use. The information I have supplied above can be used to activate this modem for my service plan in 24 hours unless I call to cancel. If adequate signal is not available, this modem will be returned, in the same condition as I received it, with all property of Clearwire in proper working order. 

I further acknowledge and agree that I will be responsible and will pay for any damage to or loss of the modem and/or equipment up to $300.00.

 I accept these Terms of Service.

VoIP Internet Phone Service Registration   <- Check box to Add Internet Phone
Phone Adapter MAC address example: 000E08EC7907 (12 characters)
911 Address Look up USPS 
   Customer Signature:  Initials:
   Customer Name:   Date: Date activated:  

getconnected@centralsystems.us