Montana Satellite & Wireless

"Satellite Entertainment & Communications"

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Service Request Form

 

 

This form can be used to setup WildBlue monthly service account for new and used WildBlue Equipment.
If you have purchased your equipment from Montana Satellite & Wireless, this service is free.

If you have not purchased your new or used equipment from Montana Satellite & Wireless, there is a $ 35.00 charge for this service. (billed to the card submitted below).

 

 

NOTE: New Equipment plans may required a 12 month commitment to service!
 

All WildBlue Service for new and used equipment is currently provided by the new WildBlue 1 Satellite and requires a "right-handed" tria.
Some new and used equipment services are still available on the Anik F2 Satellite upon request and requires a "left-handed" tria.

 

 

Option - Dial-up account 

 

 

INSTALLATION INFORMATION

 

First Name:    
Middle Name: 
Last Name:    

Customer Name:            (can be a business name or full name... example:  John Doe... or Doe Plumbing, etc.)

 

Installation Address:    
Installation Address:    

Installation City:               Installation State:                                      Installation Zip: 

 

Installation Phone:           Installation Phone:            E-mail Address:

 

 

BILLING INFORMATION (must be the same as the credit card billing address)

 

First Name:  

Middle Name:

Last Name:  

 

Billing Address: 

Billing Address: 

Billing City:            Billing State:                                            Billing Zip: 

 

Billing Phone:        Billing Phone:        E-mail address:

 

SOC. SEC. #:        (for obtaining credit approval only)

 

 

Approximate Installation / Activation Date:         AM       PM

 

Please choose a 4 digit PIN Number for your new WildBlue Account:     (will default to the last four digits of your primary phone number)

 

Site Name:      (use to differentiate from other systems you may have under your name, etc.... example: Lake House)

 

 

 

PAYMENT INFORMATION

 

Credit Card Type:      (required for monthly billing)

 

Credit Card Number:                       Credit Card Expiration Date:     (format:  01/06 or 01/10/06)

 

Name as it appears on card:        Credit Card Security Code:       (last 3 digits on back of card if available)

 

Mother's Maiden Name (for WildBlue verification):

 

 

Please select from the following that best describe your installation status:

 

Installation Status:     I have the system installed already              I am in need of installation services

 

 

The above information will be used by Montana Satellite & Wireless to setup your WildBlue Monthly Service account only.  We will not offer your information to anyone other than WildBlue.  Montana Satellite & Wireless is not responsible for WildBlue service, and by submitting this information, you agree to the WildBlue Terms and Conditions and to any contractual service obligations, etc.

 

By submitting this information, you must agree that you are submitting the above information as fact and that you are the individual requesting WildBlue service and that you are authorized to use the credit card information being provided.  You also understand that any fraudulent or misleading information may result in a suspension of your HughesNet service and possible legal remedies.

 

If your equipment was / will be purchased from someone other than Montana Satellite & Wireless, a $ 35.00 charge will be applied to the credit card above for this account setup service that you are requesting.

 

If the above statements and information is true and correct, please press submit.   We will contact you via telephone or e-mail with your new account information and to schedule the sales, and/or installation of your system if requested.

 

Thank you!

 

 

 

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