• CCP Online Account Internet Direct Connection (Broadband) Sign-up


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  • FileName: InetDirectConnectionSignupForm.pdf [preview-online]
    • Abstract: CCP Online Account Internet Direct Connection (Broadband) Sign-upAccount #Please Print and fill out the following:ORDER INFORMATIONDate of Birth (DOB)S.S # or Driver’s LicenseBusiness ID#Business Name

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CCP Online Account Internet Direct Connection (Broadband) Sign-up
Account #
Please Print and fill out the following:
ORDER INFORMATION
Date of Birth (DOB)
S.S # or Driver’s License
Business ID#
Business Name
Street Address Suite/ Floor
City State Zip
Occupation
Referred by
Primary Contact Name Phone E-Mail
Local Telephone Co Name
Installation Contact Phone E-Mail
Installation Location
Technical Contact Phone E-Mail
BILLING INFORMATION
Business Name
Contact Name
Contact Title
Address Suite/ Floor
City State Zip
Phone Number Fax
E-Mail
DIRECT CONNECTION SERVICE PACKAGES
Which Plan ISDN64K ISDN128K SWB-ADSL128 SWB-ADSL384
CEN-ADSL128 NEN-IDSL144 NEN-SDSL192 NEN-SDSL384
NEN-SDSL768 NEN-SDSL1.1 NEN-SDSL1.5 NEN-REACH384
NEN REACH768 NEN-REACH1.1 NEN-REACH1.5
Type of Plan q BASIC q ENHANCED
Equipment Needed q YES q NO
MASTER ACCOUNT INFORMATION
The Master Email account information will be used for the following:
• Technical support, access to CCP Online systems to create additional Email boxes and change passwords.
• Monthly billing information & post installation communications.
Please choose your username and password. This has to be between 4 Full Name
and 8 letters or numbers. The username and email must not begin with a Username
number. The password may begin with a number(s). Password
Please choose which METHOD OF PAYMENT:
BILL LATER
Automatic credit card debit requires a separate form. Also, Direct Deposit also requires a separate form.
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©2000 CCP Systems Version 2
All Rights Reserved
CCP Online Account Internet Direct Connection (Broadband) Sign-up
Check Number Amount Paid
Credit Card Number Exp. Date
TERMS AND CONDITIONS
Please read and sign the following agreement
This CCP Online Service Agreement (the “Agreement”) is made between the provider of CCP services, Cook’s Computer/CCP
Online. (“CCP”), and the Customer identified below. CCP services and facilities are provided on the terms and conditions contained
herein. Customer and any person using any CCP services or facilities accept these terms and conditions and agree to be bound by
them.
1. Acknowledgement: Customer acknowledges and understands that Customer is to receive the services detailed in this
Agreement and the Customer is not relying on any affirmation of fact, promise or description from any person or entity, nor any
other oral or written representation other than what is contained in this Agreement.
2. Installation: Service installation is complete once CCP verifies Internet connectivity to Customer via a CCP DSL circuit
connection to a standalone workstation on the Customer’s network. CCP will not be responsible for any LAN equipment,
configuration, or connectivity beyond this single point. CCP will return the workstation to original settings if CCP configurations
conflict with workstation’s LAN connectivity
3. User Responsibilities: Users are responsible for all charges associated with their account. In the event of any unauthorized
access to your account, the user MUST notify CCP in writing, e-mail, or by phone; however, the user will remain responsible for
all charges until CCP is notified. All accounts are for pers onal, non refundable. No more than one concurrent user session per
account is permitted at any time. The user is prohibited from lending or giving their account password to others.
4. Billing and Payment: CCP shall bill Customer for services rendered at the rates stated herein. Invoices shall include all
applicable taxes, service charges, fees and surcharges. CCP shall commence billing upon completion of installation. First and
second month payments are billed upon service installation and are due within thirty (30) days of the invoice date. Where
applicable, service charges for the first partial month of service will be pro-rated and billed. Authorized monthly credit card
payments are charged to Customer’s credit card on the customer bill day. Bill day is when customer started with CCP. Past due
accounts will be charged a late fee of 1.5% per month on any unpaid past due balance. Delinquent accounts are subject to
immediate termination or suspension of services at the sole discretion of CCP. Customer may reinstate services suspended
due to nonpayment by paying to CCP within 30 days from the date the suspension commences a the Service Reinstatement
Fee plus all outstanding amounts due, including the cost of Direct Connection service that would have been provided during the
period of suspension. If the Customer does not choose to reinstate service with 30 calendar days, CCP will deactivate the
service without further notice and any applicable Early Termination Fee or other Fees will become immediately due and
payable.
5. Additional NRC: if applicable, will apply:
Nonstandard Installation (materials extra) $ 60
Standard Inside Move $150
Nonstandard Inside Move (materials extra) $ 60
Relocation Fee Same as Installation
Early Termination Fee (per circuit) $500
Speed Change (requires technician) $100
Downgrading Service (speeds changes only) $100
Inside Wiring Repair $ 60
Site Survey $150
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©2000 CCP Systems Version 2
All Rights Reserved
CCP Online Account Internet Direct Connection (Broadband) Sign-up
Facilities Management Riser Connection $250
Service Reinstatement Fee $100
Missed Appointment $150
Rejected Credit Card/Unpaid Check $ 20
6. Domain Name Fee: Payment for domain name registration fees are paid by the Customer after the first year. Payment for
domain periodic maintenance fees are Customer's responsibility. Such fees are not included in the prices for services except for
registration after the first year.
7. IP Addresses: Upon IP address reassignment or expiration, cancellation, or termination of the Agreement, Customer shall
relinquish any IP addressees or address blocks assigned to Customer by CCP.
8. Term: This Agreement shall commence on the Effective Date and shall continue for an initial term of one year from the date
on which customer’s first DSL circuit is installed. After expiration of the initial term, this Agreement shall continue in effect on a
month-to-month basis until terminated by either Party upon at least 30 days advance written notice to the other Party.
9. Termination: CCP may terminate services immediately upon violation of any term of this Agreement. Upon CCP’s
discontinuance of services for such violation, CCP shall, in addition to all other remedies available to CCP at law or in equity,
assess and collect from Customer any applicable Early Termination Fee. Customer must, at its own expense, return any CCP
equipment within ten (10) days of the Termination Date. Otherwise, Customer shall be financially responsible and CCP shall
invoice Customer for such equipment, with payment due within 30 days of invoice date. An Early Termination Fee applies if
Customer chooses to terminate Direct Connection service any time from the date Customer submits its order until one year after
the date on which Direction Connection service is installed. This Early Termination Fee will be waived if (i) Customer cancels its
order within 5 business days of placing it; (ii) CCP cannot install Customer’s DSL service within 50 days after accepting the
order, and Customer chooses not to wait for CCP to complete the installation; or (iii) for a period of more than 20 business days
after Customer informs CCP of the problem, Customer’s Direct Connection service is inoperative or unable to transport data
reliably at the speed accepted at the time of installation, and Customer then chooses to deactivate.
10. Service Level Credits: Upon a Customer's' request, CCP will credit to that Customer's account an amount equal to the
connectivity charges for five (5) times the length of any DSL unscheduled service outage of at least two hours duration, provided
that Customer notifies CCP immediately of such outage, and that CCP reasonably determines that such outage was attributable
to CCP and not to any actions or inactions of Customer or any third parties (including failure of third party equipment. Customer
credit may not exceed one month's service fees in any single calendar month. Customer must request credit in writing or via e-
mail the credit within 72 hours of service restoration.
11. Acceptable Use Policy: Customer and all of its employees shall abide by the terms of the Acceptable Use Policy set forth at
http://www.ccp.com/legal/acceptableuse.html and incorporated herein by reference. CCP may immediately terminate services
for violation of this policy at any time without giving Customer any advance notice.
12 Liability and Warranty Disclaimer: Customer recognizes that CCP cannot control the content transmitted on its network and
the Internet and that communications on the Internet may not be secure and may be subject to interception or loss. CCP
disclaims liability for, and Customer hereby releases CCP from, all damages (such as business losses, liabilities, costs,
attorney’s fees and expenses) incurred by Customer arising out of or relating to use of CCP services. Except for the service
level credit commitment specifically provided for herein, CCP services are provided “AS IS” without any representations or
warranties either express or implied. CCP HEREBY EXPRESSLY DISCLAIMS ALL IMPLIED WARRANTIES INCLUDING
WARRANTIED OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.
13. Indemnity: Customer shall indemnify and hold harmless CCP from and against any loss, cost, claim, liability, damage, or
expense (including reasonable attorneys' fees) to third parties, relating to or arising from the use of CCP services by Customer
or any of their personnel, whether or not Customer has knowledge of or has authorized such access or use, including, without
limitation, claims for libel, slander, invasion of privacy, infringement of copyright, patent infringement (where Customer or User
has used, connected, or combined the Service with the products or services of others), negligence, or tortuous behavior.
Customer agrees to indemnify CCP along with any parties from whom CCP obtains network services, and to hold them
harmless from any claims resulting from the use of CCP services by Customer that damage another party or violate the law.
14. Miscellaneous: This Agreement shall be governed by, construed under, and enforced in accordance with, the laws of the state
of Washington without reference to its choice of law principles. For4 NEXT PAGE
Page 3 of any action or suit to enforce any right or remedy of this
©2000 CCP Systems Version 2
All Rights Reserved
Agreement, (except for actions to enter or collect on judgments) the parties consent to exclusive jurisdiction and venue in the
courts for Buchanan County, Missouri and the prevailing party shall be entitled to recover its costs, including reasonable
attorney’s fees. In the event of a conflict between this Agreement and any applicable tariff, the tariff shall prevail. . CCP may
amend the terms and conditions of this Agreement by giving Customer 30 days' prior notice via publication on the CCP web site.
CCP may assign this Agreement by providing written notice to Customer, but Customer may not assign this Agreement without
CCP prior written consent that shall not be unreasonably withheld. CCP reserves the right, exercisable in its sole discretion, to
expand or reconfigure its service areas and to discontinue any services upon 30 days notice by email or otherwise. This
Agreement shall be binding on the parties hereto and their respective personal and legal representatives, successors, and
permitted assigns. If any provision of this Agreement is held to be invalid or unenforceable, the validity and enforceability of the
remaining provisions of this Agreement shall not be affected thereby.
15. Acceptance: By Signing below, I acknowledge that I have authority to enter into this Agreement on behalf of the
Customer, that I have read and fully understand all of the terms and conditions set forth in this agreement, and that I,
and any person using any services or facilities provided by CCP to Customer, agree to abide by the terms and
conditions of this agreement.
Customer ( Company ) Name
Customer Representative (Name)
(X)
Customer Representative (Signature) Today’s Date:
Thank you for choosing CCP Online as your #1 Internet Service Provider (ISP).
Comments
Sales Engineer Initials
Sales Manager Initials
Sales Rep Name PHONE EMAIL
Agent Name
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©2000 CCP Systems Version 2
All Rights Reserved


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