HomeMy WebLinkAboutC19-280 Visionary BroadbandService Order Form
email: business@visionarybroadband.com
phone: 307.687.9933 fax: 307.682.2519
postal mail: Visionary Broadband . PO Box 2799 . Gillette WY 82717-2799
physical: Visionary Broadband . 1001 S Douglas Hwy . Suite 201 . Gillette WY 82716
Please execute Service Order Form and fax a copy to the number above, then mail a hard copy to the address above. ver 0519
10MB Private Line. 36 mo. term
New circuit will replace existing circuit ID: 64611033
Ethernet 10Mb $299.00
Monthly CPE Lease $25.00
Percentage of Interstate
Utilization (PIU – 0% or 100%): 0 %
Charges: Term: 36 Months
$324.00 MRC, does not include current taxes
$0.00 NRC
NRC = Non-Recurring Cost, MRC = Monthly Recurring Cost
500 Broadway St. Eagle CO 81631
100 W Beaver Creek Blvd Avon CO 81620
Company Name: Eagle County Avon Annex FVAI
Contact Name:
Billing Email: scott.lingle@eaglecounty.us
Billing Address: PO Box 850
City/State/Zip: Eagle CO 81631
Phone: 970-328-3581
Tax ID:
Circuit Description:
Location A
Company:
Service Address:
Local Contact:
Local Phone:
Location Notes:
Visionary Communications, Inc.
signed: dl.signhere.2
print: dl.fullname.2
title: dl.title.2
Account Number: SF-273196
Service Order Number: SO-00005449
Contract Date: August 13, 2019
Requested Due Date:
Jurisdiction certification: Intrastate
Location Z
Company: Eagle County Avon Annex FVAI
Service Address:
Local Contact:
Local Phone:
Location Notes:
Eagle County Avon Annex FVAI
signed: dl.signhere.1
print: Jeff Shroll
title:
Your signature below acknowledges you have read, understand and accept the Terms of this Service Order Form. This Service Ord er Form is
subject to the Visionary Broadband Dedicated and High-Cap Service Agreement between the companies below, including the term length displayed
on this form, and that you are duly authorized to execute and deliver this Contract as of the date set forth below.
DocuSign Envelope ID: 393AE5AA-C96D-4CA0-A539-D528914C9A04DocuSign Envelope ID: 761C68D9-4389-4EC4-BFFB-B86FB1104680
VP Of Operations
Gina Dillard
County Manager
