Alternate Contact:
Alternate Name:
Alternate Phone:

Technical Contact:
Name:
Phone:
Fax:
E-mail:

Building Management Contact:
Mgt. Co:
Name:
Phone:
E-mail:

Location Information:
Location Type: Select One Business-High rise-multi tenant  Business-High rise-single tenant  Business-Campus or office park-multi tenant  Business-Campus-single tenant  Business-single building  Residence-House  Residence-House in complex  Residence-Apartment building 
Quantity of PC’s at location: 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60
Quantity of Servers at location 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60
Do you want to host your own web site at your location? Yes No
Do you want to host your own E-mail at your location?
Yes No
Do you run DHCP on your network?  YesNo

Domain Names Requested:
1.Transfer
2.Transfer

Credit Card Information:
Prepayments will be invoiced.  However, a credit card number is needed for backup and verification of your identity. Business accounts do not need to provide credit card information.

Name on CC: 
Address: 
City: 
State:
Zip:
CC Type:  Select One Visa MasterCard American Express Discover
CC #:
(must print form, and write in credit card number before faxing to AstraGate)
CC Expiration Date: (mmyy)

Do you want your first prepayment to be by check or credit card? Select One Credit Card Check

I, , allow AstraGate to use my credit card number for the payment of the above described purchase. I also allow any monthly recurring charges to be paid with the use of my credit card number. All terms and conditions of the AstraGate FAST DSL Service Agreement apply to the purchase, and the use of this credit card.

Signature:                             

Billing Information:
Contact:
Address:
City:
State:
Zip:
Phone:
Fax:
E-mail:

Your Purchase Order No.:
Referred by:

Step 3)
      *FAST DSL Equipment: (Check One)

      *Signature:                                             

Service Date.  The Service Date shall be the date any AstraGate Services ordered under this Agreement are first available for use by the Customer.
 Initial Term.  The Initial Term for the Agreement shall be for   12   month(s), beginning on the Service Date.
 Renewal.  The Agreement shall renew automatically for an additional term, equal the period of the Initial Term, unless notification of non-renewal is provided by either party not less than 30 days prior to the expiration of the Initial Term or renewal period.
 Price Changes.  AstraGate reserves the right to change its prices at any time by giving 30 days prior notice to customer. Customer may elect not to accept any increase in price, at which time AstraGate may decide at its sole discretion, to cancel this Agreement and terminate service.
 Cancellation.  The Agreement is cancelable by payment of all fees due for the remainder of the Initial Term, or if the Agreement has been renewed, for the renewal period.
 Payment.  Initial Fees are payable in advance of order. Monthly Fees will be billed monthly in advance beginning one month from the Service Date. Payment of Monthly Fees is due upon receipt of invoice, and is delinquent if not received within 15 days. Any Fees not received 30 days from the date of invoice are subject to a late charge of 1 ½ % per month or a thirty-dollar late fee per incident.
 Taxes.  Customer agrees to pay any sales, use, gross receipts, excise, access, bypass or other local, state and Federal taxes or charges, imposed on or based upon the provision, sale or use of the AstraGate Services.
 Interruption of Services.  Services may be interrupted if any fees remain unpaid 30 days from date of invoice, or if Customer engages in any conduct or activities which AstraGate in its sole discretion believes violates any of the term of this Agreement. An interruption of service does not relieve Customer of its obligation to continue to pay monthly fees.
 Assignment.  Customer shall not, without prior written consent of AstraGate, which shall not be unreasonably withheld, assign, transfer or in any other manner dispose of, any of its rights, privileges, or obligations under this Agreement.
 Customer Equipment and Facilities.  Customer shall at its own expense undertake all necessary preparations to comply with AstraGate’ installation instructions. If Customer is not ready to accept AstraGate Services 30 days after the Planned Service Date, AstraGate may begin billing Monthly Fees using the Planned Service Date as the Service Date. Customer is responsible for the use, compatibility and maintenance of all Customer owned equipment.
 Letter Of Agency  (LOA).  Customer hereby authorizes AstraGate to act on its behalf with the Local Exchange Carriers and others for the provisioning of local access required as part of the AstraGate Services. This LOA shall remain in effect until cancellation by Customer in writing.
 Acceptable Use.  AstraGate Services may only be used for lawful purposes. Transmission of any material in violation of any Federal, state or local regulation is prohibited. This includes without limitation material protected by trade secret, copyrighted material, and material legally judged to be threatening or obscene. Any access to and use of other networks connected to AstraGate, including the Internet, must comply with the rules and behavior guidelines of that network. The sale of Internet access by Customer using the connection provided under this agreement to another entity, which sells IP transit to others, is expressly prohibited.
 Servers.  Servers are only allowed on specified packages No commercial or business servers, of any kind, are allowed for DSL-Only Package.
 No Warranty.  AstraGate Services are provided on an “as is” and “as available” basis without warranties of any kind, either express or implied, including but not limited to warranties of title, non-infringement or implied warranties of merchantability or fitness for a particular purpose. No advice or information given by AstraGate or its affiliates shall create a warranty. Neither AstraGate nor its affiliates warrants that the service will be interrupt or error free or that any information, software or other material accessible on the service is free of harmful components. Under no circumstances shall AstraGate or its affiliates be liable for any direct, indirect, incidental, special, punitive or consequential damages that result in any way from the use of or inability to use AstraGate Services, or Customer’s reliance on or use of information, services or merchandise provided on or via AstraGate Services, or that result from mistakes, omissions, interruptions, deletion of files, errors, defects, delays in operation, or transmission, or failure of performance.
 Indemnity.  Customer agrees to defend, indemnify and hold AstraGate and its affiliates harmless from any and all liabilities, costs and expenses, including reasonable attorney’s fees, settlement payments and any damages awarded related to or arising from: (1) any violation of this Agreement by Customer or its affiliates; (2) the use of AstraGate Services or the placement or transmission of any message, information, software or other materials on any other network connected to AstraGate; (3) negligent acts or omissions of Customer or its   in connection with the construction, installation, maintenance, presence, use or removal of systems, channels, equipment or software not provided by AstraGate which are connected or are to be connected to AstraGate Services; and  (4) claims for infringement arising from the use of equipment and software, apparatus and systems not provided by AstraGate.
 Disputes.  This agreement shall be construed in accordance with the laws of the state of California. For purposes of Venue and Jurisdiction, this Agreement shall be deemed made and to be performed in the City of Santa Clara, CA.
 Entire Agreement.  This Agreement supersedes all prior representations, agreements and understandings whether oral or implied, and may only be modified in writing.
Agreed to as of this Effective Date:
I have read and understand the above Service Agreement, and I authorize these services to be ordered.

Authorized Signature:                                                       
Print Name:
Title:
Company Name:
Social Security  or Tax ID#:
Address:
City:
State:
Zip:
Phone Number:
Fax Number:
E-Mail: