Small Commercial Service Change Form

Small Commercial Service Change Form

Revised 10/1/24
This is to be used ONLY for Red Bolt Broadband service. Any changes to an existing CDEC electric account must be made separately on the form designated for such changes. A Service Agreement must also be completed and returned before installation.
Customer Name*
Account Number
Service Address*
Phone*
Email Address*
example@example.com
By adding or returning equipment, I understand the changes and charges as shown below, plus tax, will be reflected on my monthly billing statement, from the date on this form going forward.*

UpgradeDowngradeAdd Device/IP addressReturn Device
If you would like to change your service plan or add a device, please choose from the following options.

$99.95/month: 100/100 Mbps$129.95/month: 250/250 Mbps$149.95/month: 500/500 Mbps
$7.00/month: Managed Wireless Router$3.95/month: 5Ghz WiFi Extender$3.95/month: Public IP Address
By adding or returning equipment, I understand the charges above, plus tax, will be reflected on my monthly bill, from the date on this form going forward.
Router / 5GHz Wi-Fi Extender*

Pick-UpReturn
I am ADDING a router and/or Wi-Fi Extender. FSAN number on equipment:
I am RETURNING a router and/or Wi-Fi Extender.* FSAN number on equipment:
Reason for Return/Exchange:*
*By signing this form, I understand that a $20 cleaning fee plus tax, per device, will be assessed if the equipment needs cleaning. If the equipment is returned unusable (e.g. returned without power cord or damaged), I am responsible for full retail value of the equipment.
$20.00 Cleaning fee required?:

Yes:No:
Signature*

Clear
Date

MonthDayYear
Date
1821 Clif Lear Ave. / PO Box 1087 / Grants, New Mexico 87020 / redboltbroadband.com / Ph: 505.876.2005 / Fx: 505.287.2234
Should be Empty: