Mobius Business/ Residential Fiber Name Name First First Last Last Billing Address Billing Address Billing Address Billing Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Physical Address Physical Address Physical Address Physical Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Phone Unlimited Fiber Internet Service Internet 25 Mbps $40 50 Mbps $60 100 Mbps $85 200 Mbps $115 300 Mbps $145 Up to 1 Gig call for pricing Router ALL INTERNET PACKAGES AREUNLIMITED BANDWIDTH Telephone Service Phone Mobius Business Phone $27.50 with taxes & fees $40.64 Mobius Residential Phone $17.50 with taxes & fees $27.50 Caller ID Name/# $4.00 Call Waiting $1.50 Call Forwarding $1.50 3-Way Calling $1.50 Voice Mail $2.00 Telemarketing Block $2.00 Selective Call Reject $2.00 Call Forward Busy $1.50 Wire Maintenance $4.00 more features on the other side $25 Unlimited Long Distance anywhere in the US $5 Hi 5 Plan 100 minutes per month Over 100 minutes is.10 per minute $15 250 minute Long Distance Anywhere in the US, any minutes over 250 are .10 per minute 10 Cents a Minute Plan All calls are .10 per minute anywhere in the US - no monthly service fee Call Forwarding - Variable $1.50 Call Forward-Don’t Answer $1.50 Selective Call Forwarding $2.00 Toll Restrict FREE Additional Directory Listing $0.50 Anonymous Call Rejection $2.00 Automatic Callback/Last Call Return $2.00 Automatic Callback/Last Call Return $2.00 Distinctive Ringing/Custom Ringing $3.00 Speed Calling $2.00 (8 pre selected numbers) (30 pre selected numbers) Unlisted Name & Number $1.50 Unpublished Name & Number $1.50 Please note: Prices & Services subject to change Adding features and other Mobius products will cause taxes to change. A $5.00 order fee will be assessed when new features are added to the line. Do you currently qualify for Nebraska Telephone Assistance Program? Yes No I HAVE RECEIVED THE INFORMATION REGARDING MY RIGHTS OF CPNI. (CUSTOMER PROPRIETARY NETWORK INFORMATION) Yes No Cobalt FiberTV Packages Fiber TV Element Package $56.95 Essential Package $113.45 Ultra Package $123.95 HBO $15.95 CineMax $13.95 Showtime $10.95 Starz & Encore $13.95 Wholehome DVR $16.95 # of Set Top Boxes 1st Standard Set Top Box - Free Each Additional Set Top Box - $6.95 Protection Plan $5.95 I certify I am at least 18 years of age. The phone number(s) listed on this Authorization are listed in my name and/or I am authorized to change the preferred carrier for each of the Services requested above. My signature on this form authorizes Mobius Communications Company to act as my agent to change my current carrier to Mobius Communications Company and to use my account information to do so for those services. I understand that I may designate only one primary carrier for each of the Services requested above; that there may be a fee charged to change the Service(s); and that I may consult with the appropriate carrier to determine if a fee applies to this change. I understand that no change will take place without my signature; and if I choose not to change my telephone company, my current company will continue to provide service without interruption. Name Name First First Last Last Date Signature signature keyboard Clear If you are human, leave this field blank. Next