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District of Columbia
Florida
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Hawaii
Idaho
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Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
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New Mexico
New York
North Carolina
North Dakota
Ohio
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Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
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Texas
Utah
Vermont
Virginia
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West Virginia
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Authorized Person Phone #:
Authorized Person Email:
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Service(s) / Subscription(s):
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Mobile Wireless
Home Internet
Business Internet
Data Only
TV
Please select all that apply...
WaveNetworks Mobile #:
*
Wireless Plan:
*
Silver ($25.00)
Gold ($30.00)
Platinum ($50.00)
ACP Only ($0.00)
ACP Tribal Benefits ($0.00)
Wireless Network:
*
GSM-A
GSM-T
Wireless ICCID #:
*
Wireless MDN #:
*
Wireless Activation Date:
*
Home Internet Plan:
*
Small Connect ($65.99)
Home Connect ($80.99)
Home Connect Plus ($92.99)
Home Connect Super ($112.99)
ACP Only ($35.99)
ACP Tribal Benefits ($0.00)
Home Internet Network:
*
GSM-A
GSM-T (Data Only)
iQsim
Home Internet ICCID:
*
Home Internet Activation Date:
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Business Internet Plan:
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Small Size ($99.99)
Mid Size ($119.99)
Large Size ($149.99)
Fail Over-Backup ($45.99)
Business Internet Network:
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GSM-A
GSM-T (Data Only)
iQsim
Business Internet ICCID:
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Business Internet Activation Date:
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Data Only Plan:
*
Simple ($19.99)
Advance ($25.99)
Advance Plus ($39.99)
ACP Only ($0.00)
Data Only Network:
*
GSM-T
GSM-A
GSM-T (Data Only)
Data Only ICCID #:
*
Data Only Activation Date:
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TV Plan:
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WN TV BASIC
WN TV Plan
TV PIN:
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TV Streaming Credentials:
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First
Last
How many device(s):
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One (1)
Two (2)
Three (3)
Four (4)
Five (5)
TV Streaming Activation Date:
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