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New Service RequestRequest new Internet Service

Customer and Location:

NAME:

INSTALL LOCATION (street address and town):

Billing Information:

ADDRESS:

CITY:

STATE:

ZIP:

PHONE:

EMAIL ADDRESS:

How You Use the Internet:

Streaming Movies or Video

Gaming

Email

Work from Home

Distance Learning

Meet with Doctors (telehealth)

Remote Security Cameras (vacation property)

Number of Users at the Same Time

Requested Download Speed 5 Mbps 10 Mbps 15 Mbps Unsure

Special Requests or Instructions:

Are You a Robot:

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Thank you for submitting your New Service Request. We will review your information get back to you soon.

Or contact us at:

Barger Creek Wireless
11336 Mouch Road
Atlanta, MI 49709

Phone: 989-341-3417

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