Carrollton Interest Form Green Hills - Carrollton Business/Residential It’s time to start planning your Fiberhood! Show your interest today!” This form is for fiberhood planning purposes only. Completing this form does not commit you to taking services from Green Hills or guarantee these services will be available through Green Hills. Please choose your service type. * ResidentialBusiness Company Name * Title of Primary Subscriber Mr.Ms.Mrs.Dr.Jr. First Name Last Name Date of Birth Daytime # Evening # Email (This email will be used for status updates on your Fiberhood's buildout) Service Address Service City Service State Service Zip Is your Mailing address different from your Service address? Yes, they are different. No, they are not. Mailing Street Address Mailing City Mailing State AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY Mailing Zip Potential Fiberhood Services Please tell us which services you would be most interested in receiving if a fiberhood was built in your area. Ultimate_container package-table"> Please select your Service Package Package Total Care Plan (Maintenance Protection) * Yes, I would like Customer Care I would like more information No, Thank You Ultimate WiFi (includes parental controls, device prioritization, virus/malware protection, and much more! One time $50 WiFi Analysis Fee) * Yes, I would like WiFi throughout my home I would like more information No, Thank You Unlimited Local and Long Distance Phone Service Unlimited Local & Long Distance Phone(Includes: Voicemail, Caller ID, Call Waiting, 3-Way Calling, Call Forwarding) No Thank You *Federal, state + local taxes + fees are not included, Long Distance includes calls made to lower 48 US States only, calls made to Hawaii, Alaska, US Territories or international countries will incur additional fees. Number of phone lines that need service 1 Phone Line2 Phone Lines Would you like to keep your current home phone number? Yes No Who is your current provider? * AT&TCenturyTelZitomediaSocket Telecom Current Phone Number Current Phone Number Line 2 UPS Battery - Notes: Phone service will NOT work in case of power outage without a UPS battery backup installed. This is not mandatory, but without a UPS battery backup installed, access to E911 will not work when power is out. * Yes, I would like more information No, Thank You *An uninterruptible power supply/backup battery that maintains power or up to 8 hours or 24 hours are available upon request. reCAPTCHA Submit
