Basic Voip Form Mitec Basic VoIP Business Name*Name* First Last Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Billing Address (If applicable) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Enter Email Confirm Email I need phone numbers to be ported (max 2 Phone numbers) Phone number 1Phone number 2Current Phone Service Provider*At&TVerizonFrontierSpectrumOtherAccount Number*Account Name (as listed on bill)*Account Service Address (as listed on bill)*City*State*Zip*Monthly AgreementMonthly phone service rate*Mitec Basic VoIP - $24.99 / per lineBasic Phone Service Installation: $149.99 Telo Box Required (not included): $49.99 + tax (Telo Box supports up to 1 phone number) Custom Phone Service Installation: $120 / hr (If your home or office needs special wiring done to complete the installation) Telo Box and phone handset must be placed next to the router. If this isn't possible and wiring is necessary to connect all phones in the house or office, you will need a custom installation.* I understand and agree to the installation terms. Mitec Solutions Service Terms and Conditions By requesting service from Mitec Solutions I agree to the following terms and conditions: Phone Rates and Conditions Phone Service rates are listed above and will not change during the duration of the agreement length. Month-to-month rates may change at any time without notice. Current rates are available to view at mitec.net/rates. Phone Service Installation (if applicable) includes active data connection up to a single Main Point of Entry (MPOE). Mitec will verify the incoming connection is live, with either a private dynamic IP or public static IP (if requested). Mitec will connect to a single non-business class router which requires the administration password. If router password is unkown, or the router is a business-class router, or there are any other advanced network features beyond WAN connection, simple DHCP server, and NAT that need to be configured additional labor will be charged. WiFi is not guaranteed due to radio interference, building construction, and other physical anomalies. A basic router can usually provide WiFi for up to 1,000 sq. ft. Larger areas, or areas with significant wireless interference, will require additional equipment and labor, to be determined during installation. During installation it may be required to drill holes into the building to mount antenna and bring cable inside. Mitec is not responsible for any damage to the building or property as a result of Internet installation. I.T. Service Labor Rates Remote labor is billed at $95/hr with a 15 minute minimum charge. In store labor is billed at $95/hr with a 1 hour minimum charge. On site labor is billed at $120 with a 1 hour minimum charge. Mitec labor rates listed above are for regular business hours only, and are subject to change without notice and available to view at mitec.net/rates. Release of Liability By initiating a service call, in-store, on-site, over the phone, or remotely, including all future service, support, or repair, I acknowledge that support services provided by Mitec Solutions may result in malfunction of certain programs or functions of my personal computer, networking equipment or peripherals and that this may occur through no fault of Mitec Solutions. Knowing and understanding the risk of accepting the support services of personnel of Mitec Solutions I affirmatively forever release and hold harmless Mitec Solutions, its owners, employees and vendors against any loss, liability, or damage that I or the owner or lessee may suffer including, but not limited to, any loss of any data, virus infection, security breach, or the non-functioning of any component or element of my computer equipment, network equipment, or peripherals regardless of any warranties, disclaimers and waivers. Furthermore I agree in advance to release, waiver, forever discharge, and covenant not to sue Mitec Solutions, any of its employees, officers, or agents from and against any and all liability for any harm, injury, damage, claims demands, actions, causes of action, costs, and expenses of any nature that may result from support services I accept for my personal computer or other I.T. service. In any legal dispute the non-prevailing party shall pay all fees, including court and attorney fees, and all other fees, of the prevailing party. In event issues cannot be resolved remotely, further labor for additional troubleshooting will be charged at our standard in-store or on-site rate. I agree to these terms and agree to the labor rates stated above and agree to pay any open balance within 15 days of receiving an invoice. Any unpaid balance on Internet, web-hosting, or other monthly recurring service will be suspended after 30 days and a re-connection fee may apply. Any unpaid balance on labor and hardware will be charged a 1.5% finance fee every 30 days. Remote labor and onsite labor comes with no warranty. In-store labor comes with a 7 day warranty. This agreement, including all rates, terms, and release of liability is ongoing forever and applies to any and all future labor requests including in-store, on-site, or remotely. Terms of ServiceSignature*Upload Current Phone Bill*Referred by First Last EmailThis field is for validation purposes and should be left unchanged.
