Simplified Customer / Master Form Customer Form (Simple) Customer InformationBusiness Name Customer Name* First Last Service Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number*SMS Cell number for Outage Notifications*Email Address* Billing Address* Same as Service Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Plan InformationInternet Package* Monthly Price*Agreement Length* 1 Year Agreement 2 Year Agreement 3 Year Agreement 4 Year Agreement 5 Year Agreement Month to Month Agreement Installation Fee*Purchasing Equipment?* One Time Fee Purchase Monthly Fee Purchase Using Customer's Equipment Equipment (One Time Fee)* Equipment Price (One Time Fee)*Purchasing More Equipment (One Time Fee)? Yes Equipment 2 (One Time Fee)* Equipment 2 Price (One Time Fee)*Equipment (Monthly Fee)* Equipment Price (Monthly Fee)*Purchasing More Equipment (Monthly Fee)? Yes Equipment 2 (Monthly Fee)* Equipment 2 Price (Monthly Fee)*HiddenMitec Managed WiFiWould you like Mitec Managed WiFi? Yes No Select a Plan*3500 Sqft Coverage @ $19.995000 Sqft Coverage @ $29.99CostsHiddenBusiness or Residential Business Residential Auto Pay I would like to set up autopay and I agree to have my payment method automatically charged By agreeing to auto-pay you are allowing Mitec to process your monthly payment automatically each month. By agreeing to auto-pay you will receive a $5 monthly discount, if we are unable to process your auto payments for 2 or more consecutive months, your auto-pay discount will be removed and your monthly invoice will increase by $5 each month. Auto Pay I would like to set up autopay and I agree to have my payment method automatically charged By agreeing to auto-pay you are allowing Mitec to process your monthly payment automatically each month.HiddenAutoPayDiscountHiddenBusinessAutoPayDiscountMonthly BillOne Time FeesFirst Bill (includes one time fees)Terms and ConditionsHidden* By requesting services from Mitec Solutions, LLC (hereafter “Mitec Solutions”), I agree to the following terms and conditions (the “Agreement”): Current Rates Remote labor is billed at $120/hr with a 30 minute minimum charge. In store labor is billed at $145/hr with a 30 minute minimum charge. Service Bench labor is billed at $95/hr with a 1 hour minimum charge. On site labor is billed at $145/hr with a 1 hour minimum charge. Emergency Rates for regular business hours are $250/hr with a 1 hour minimum charge. Mitec Solutions labor rates listed above are for regular business hours only, and are subject to change without notice and updated rates are available to view at forms.mitec.net/rates. HiddenCurrent Rates Remote labor is billed at $120/hr with a 30 minute minimum charge. In store labor is billed at $145/hr with a 30 minute minimum charge. Service Bench labor is billed at $95/hr with a 1 hour minimum charge On site labor is billed at $145/hr with a 1 hour minimum charge. Emergency Rates for regular business hours are $250/hr with a 1 hour minimum charge. Mitec Solutions labor rates listed above are for regular business hours only, and are subject to change without notice and updated rates are available to view at forms.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 the malfunction of certain programs or functions of my personal computer, servers, business machines, networking equipment, smart (or internet connected) devices, peripherals, or any other device or object 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, it's owners, employees, contractors, and vendors against any loss, liability, or damage that I or the owner or lessee may suffer including, but not limited to, the loss of any data, virus infection, security breach, or the non-functioning of any component or element of my computer equipment, network equipment, device, 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 it's 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 performed by Mitec, including 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 negligence by Mitec.HiddenRelease 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 the malfunction of certain programs or functions of my personal computer, servers, business machines, networking equipment, smart (or internet connected) devices, peripherals, or any other device or object 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, it's owners, employees, contractors, and vendors against any loss, liability, or damage that I or the owner or lessee may suffer including, but not limited to, the loss of any data, virus infection, security breach, or the non-functioning of any component or element of my computer equipment, network equipment, device, 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 it's 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 performed by Mitec, including 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 negligence by Mitec. Landlord Permission* I am authorized to request Internet Service at this address; I am the owner of the property, or I have received permission from my Landlord, or approval is not required pursuant to my lease or agreement. I agree to hold Mitec Solutions harmless and accept all liability regarding any future tenant/landlord dispute which may arise as a result of the Internet installation, equipment, or service. I will submit Landlord Permission Form Landlord Permission FormPlease Upload Landlord Permission FormMax. file size: 200 MB.Attorney Fees, Governing Law, and Jurisdiction. In any litigation, arbitration, or other proceeding by which one party either seeks to enforce its rights under this Agreement (whether in contract, tort, or both) or seeks a declaration of any rights or obligations under this Agreement, the prevailing party will be awarded reasonable attorney fees, together with any costs and expenses, to resolve the dispute and to enforce the final judgment. This Agreement is governed by and construed in accordance with the laws of the State of California without regard to its conflict of laws principles. The parties agree that the jurisdiction and venue of any action brought pursuant to this Agreement properly lies in the state or federal courts located in County of Ventura, State of California. Customer hereby irrevocably submits himself, herself, or it to the jurisdiction of the Courts of the State of California, Ventura County and the jurisdiction of the United States District Court for the Central District of California for the purpose of any suit, action or other proceeding arising out of or related to this Agreement. Independent Customer hereby waives and expressly agrees not to assert, in any way, any claim or allegation that it is not personally subject to the jurisdiction of the courts named above. Customer further agrees to waive any claim or allegation that the suit, action, or proceeding is either brought in an inconvenient forum or that the related venue is improper.HiddenAttorney Fees, Governing Law, and Jurisdiction. In any litigation, arbitration, or other proceeding by which one party either seeks to enforce its rights under this Agreement (whether in contract, tort, or both) or seeks a declaration of any rights or obligations under this Agreement, the prevailing party will be awarded reasonable attorney fees, together with any costs and expenses, to resolve the dispute and to enforce the final judgment. This Agreement is governed by and construed in accordance with the laws of the State of California without regard to its conflict of laws principles. The parties agree that the jurisdiction and venue of any action brought pursuant to this Agreement properly lies in the state or federal courts located in County of Ventura, State of California. Customer hereby irrevocably submits himself, herself, or it to the jurisdiction of the Courts of the State of California, Ventura County and the jurisdiction of the United States District Court for the Central District of California for the purpose of any suit, action or other proceeding arising out of or related to this Agreement. Independent Customer hereby waives and expressly agrees not to assert, in any way, any claim or allegation that it is not personally subject to the jurisdiction of the courts named above. Customer further agrees to waive any claim or allegation that the suit, action, or proceeding is either brought in an inconvenient forum or that the related venue is improper. Billable Labor and Warranty All labor, including drive time, research, phone support, Email support, technical support and all other time spent on client’s behalf for any reason is billable at our applicable current hourly rates. Estimates are not guarantees and are subject to change due to additional issues discovered during troubleshooting or installation. Not all issues will be resolved during the first attempt and additional follow-up labor may be required and will be billed accordingly. Mitec Solutions does not guarantee the compatibility of any software or hardware and additional labor will be charged to troubleshoot and/or resolve conflicts and other technical issues as they arise. On-Site labor comes with no warranty. Remote labor comes with no warranty. In-Store labor comes with a 7- day warranty. Hardware purchased from Mitec Solutions comes with a 30-day warranty, unless otherwise stated on applicable invoice. Mitec Solutions can assist with manufacturer warranty repair or replacement on client’s behalf and charge our normal hourly rate plus shipping costs.HiddenBillable Labor and Warranty All labor, including drive time, research, phone support, Email support, technical support and all other time spent on client’s behalf for any reason is billable at our applicable current hourly rates. Estimates are not guarantees and are subject to change due to additional issues discovered during troubleshooting or installation. Not all issues will be resolved during the first attempt and additional follow-up labor may be required and will be billed accordingly. Mitec Solutions does not guarantee the compatibility of any software or hardware and additional labor will be charged to troubleshoot and/or resolve conflicts and other technical issues as they arise. On-Site labor comes with no warranty. Remote labor comes with no warranty. In-Store labor comes with a 7- day warranty. Hardware purchased from Mitec Solutions comes with a 30-day warranty, unless otherwise stated on applicable invoice. Mitec Solutions can assist with manufacturer warranty repair or replacement on client’s behalf and charge our normal hourly rate plus shipping costs. Auto Pay By agreeing to auto-pay you are allowing Mitec to process your monthly payment automatically each month. By agreeing to auto-pay you will receive a $5 monthly discount, if we are unable to process your auto payments for 2 or more consecutive months, your auto-pay discount will be removed and your monthly invoice will increase by $5 each month. Auto Pay By agreeing to auto-pay you are allowing Mitec to process your monthly payment automatically each month. HiddenAuto Pay By agreeing to auto-pay you are allowing Mitec to process your monthly payment automatically each month. By agreeing to auto-pay you will receive a $5 monthly discount, if we are unable to process your auto payments for 2 or more consecutive months, your auto-pay discount will be removed and your monthly invoice will increase by $5 each month. HiddenAuto Pay By agreeing to auto-pay you are allowing Mitec to process your monthly payment automatically each month. Term of Agreement This agreement, including all rates, rate increases, terms, and release of liability is ongoing forever and applies to any and all future labor requests including in-store, on-site, over the phone, emergency or remote.HiddenTerm of Agreement This agreement, including all rates, rate increases, terms, and release of liability is ongoing forever and applies to any and all future labor requests including in-store, on-site, over the phone, emergency or remote. * I have read the above agreement and understand and agree to all provisions. * I agree to the provisions regarding Rates, Billable Labor, and Warranty * I agree to the provision regarding Release of Liability * I agree to the provision regarding Attorney Fees, Governing Law, and Jurisdiction WiFi and Internet Speed and Fair Usage Guidelines All advertised speeds are “Up To" speeds when connected directly to modem/router via a hardwired Ethernet cable. Due to WiFi anomalies, such as radio interference, building construction, size of building, device limitations, and other variables WiFi speeds may not achieve the maximum bit rate. A standard WiFi router at cover approx 1200 Sq. Ft. but is not guaranteed. WiFi is considered a luxury; any critical device should be hard-wired to the router for the most reliable service possible. Additional equipment may be required to resolve WiFi issues and is billed at our applicable rate. The Internet service is a best-effort service, meaning speeds are not guaranteed and may fluctuate due to network congestion during peak usage. Mitec will make all possible efforts to ensure speeds are consistent and will perform upgrades as necessary to maintain a high level of quality. Mitec reserves the right to limit or block network traffic which is negatively impacting the speed of the network, including but not limited to, blocking/limiting illegal websites, torrents, or other file-sharing networks used to share illegal content, or otherwise degrading the quality of service. All network priority will be given to websites, video streaming services, VOIP services, and other "normal" Internet traffic as determined by Mitec. "Abnormal" Internet traffic may be limited at any time at the discretion of Mitec if it is determined detrimental to the quality of the service.Hidden* WiFi and Internet Speed and Fair Usage Guidelines All advertised speeds are “Up To" speeds when connected directly to modem/router via a hardwired Ethernet cable. Due to WiFi anomalies, such as radio interference, building construction, size of building, device limitations, and other variables WiFi speeds may not achieve the maximum bit rate. A standard WiFi router at cover approx 1200 Sq. Ft. but is not guaranteed. WiFi is considered a luxury; any critical device should be hard-wired to the router for the most reliable service possible. Additional equipment may be required to resolve WiFi issues and is billed at our applicable rate. The Internet service is a best-effort service, meaning speeds are not guaranteed and may fluctuate due to network congestion during peak usage. Mitec will make all possible efforts to ensure speeds are consistent and will perform upgrades as necessary to maintain a high level of quality. Mitec reserves the right to limit or block network traffic which is negatively impacting the speed of the network, including but not limited to, blocking/limiting illegal websites, torrents, or other file-sharing networks used to share illegal content, or otherwise degrading the quality of service. All network priority will be given to websites, video streaming services, VOIP services, and other "normal" Internet traffic as determined by Mitec. "Abnormal" Internet traffic may be limited at any time at the discretion of Mitec if it is determined detrimental to the quality of the service. * I understand and agree to the provision Regarding Speed, WiFi, and Fair Usage. * I agree to all prices stated and agree to pay any open balance within 15 days of receiving an invoice. I agree to receive invoices via Email. All services will be suspended after 30 days of non-payment and a re-connection fee may apply. A 30 day cancellation request is required for all month-to-month services. Any unpaid balance will be charged a 1.5% finance fee every 30 days. Early cancellations or disconnects are subject to payment of remainder of term. By Signing Below I indicate that I have read and agree to all terms and conditions.* Reset signature Signature locked. Reset to sign again Referred by First Last HiddenDate IP