Residential Subscriber Order Form

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Payment Method (Check One Box) Bank Account Auto-Deduction    Credit Card Auto-Deduction     Written Paper Check

WHA-LA!® HIGHSPEED INTERNET SERVICE PLANS (Check One Box)
Bronze 10Mbps upload/download $49.95/month (includes managed router/switch)
Silver 14Mbps upload/download $59.95/month (includes managed router/switch)
Gold 20Mbps upload/download $79.95/month (includes managed router/switch)
Platinum 30Mbps upload/download $109.95/month (includes managed router/switch)

LOCAL CONNECT® TELEPHONE SERVICE PLANS (Check One Box(es))
Budget Plan $16.95 plus .035/minute 1+ outbound domestic long distance calling
Premium Plan $24.95 plus 0.00/minute 1+ outbound domestic long distance calling
Voice Mail $5.00 per voice mail box

HD TV SERVICE ANTENNA (Used to recieve free over the air HD TV Broadcasting) (Check One Box)
Standard HD TV Antenna $100.00 Installation Fee and $7.95/month Equipment Rental Fee
High Gain HD TV Antenna $125.00 Installation Fee and $8.95/month Equipment Rental Fee
NOTE: MTA's HD TV Service Antenna and Equipment Rental Fee option is only available in conjuction with ordering MTA's WHA-LA!® High Speed Internet Service for a minimum twelve (12) month term.

SUBSCRIBER AGREEMENT

Current agreement applies to new orders submitted after 4/4/18. Any orders submitted before this date are tied to the previous agreement by which they submitted.

I agree to subscribe to the Midwest Telecom of America, Inc (hereinafter "MTA") Services indicated on this Residential Subscriber Order Form for an initial term of twelve (12) months commencing upon the date of service installation. I agree to be bound by the terms and conditions of the MTA Residential Subscriber Agreement located at www.pickmta.com/residentialserviceagreement. I understand that if I do not fulfill the initial term I will be responsible for payment of early termination fees. Before services are installed, I agree to allow MTA to conduct a review of my credit history with the understanding that MTA, in its sole discretion, may decline to provide Services based on the results of the credit history query. Additionally, before Services are installed I agree MTA may conduct initial testing to determine whether the Services I have selected can be delivered to my premise. I understand that if MTA in its sole discretion declines to provide the Services, either due to the results of credit query or due to the results of network testing, the Agreement shall be considered to be null and void, with neither party having further obligation or liability to the other. I agree to pay a one-time one hundred dollar ($100.00) installation fee for MTA's Residential Wha-La!® Highspeed Internet and Local Connect® Telephone Services. I hereby state that I am authorized to, and choose to, enter into this Agreement with MTA on the date indicated below. All Residential WHA-LA!® Highspeed Internet Service Plans listed in this Residential Subscriber Form will have a 350 GB monthly data transfer limit during the initial twelve (12) month term and data transfer limit may change after the initial term of twelve (12) months.


I agree to the terms of service* Date: 12/10/2018

* Clicking checkbox indicates that you have read and agree to the terms presented in the Subscriber Agreement shown above.

Midwest Telecom of America, Inc., Telephone Communications, Merrillville, IN
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Northwest Indiana cities we serve: Portage, Valparaiso, Chesterton, Burns Harbor, Michigan City, LaPorte, Merrillville, Hobart, Crown Point, Hammond, East Chicago, Gary, Griffith, Highland, Lowell, Munster, Schererville, Dyer, Lake Station and Porter.
Midwest Telecom of America, Inc.
Northwest Indiana
1567 E. 93rd Ave
Merrillville, IN 46410
1-877-PICKMTA
Sales@PICKMTA.COM