Transfer of Service Form

This form 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. The approriate Red Bolt service Agreement must also be completed and returned before installation can begin.

Customer Name*

Account Number*

Current Service Address*

Phone*

Email Address*

example@example.com

New Service Address*

Date Previous Address Disconnected*:*

*Service at new location is not guaranteed to happen the same day previous address is disconnected.

If you would like to change your service plan or add a device, please choose from the following options. (Prices do not include tax.)

$49.95/month: 100/100 Mbps$59.95/month: 300/300 Mbps$89.95/month: 1000/1000 Mbps (1 Gig)$7.00/month: Managed Wireless Router$3.95/month: 5Ghz WiFi Extender$3.95/month: Public IP Address

Please RETURN your managed router and Wi-Fi Extender (if applicable) until service is installed at the new service address, unless instructed otherwise by a Red Bolt customer service representative.

*FSAN on returned router

*S/N on returned Wi-Fi extender

By signing this form, Customer understands they are still responsible for any unpaid bill or past due amounts owed from the previous service address. Customer's first bill after transferring service will be pro-rated from the date of connection until the end of that month.

Customer is responsible for the full retail charges of all Red Bolt equipment – including managed router and Wi-Fi extender assigned for use at the former location – if the equipment is not returned within 30 days of the date on this form.

A $20 cleaning fee plus tax, per device, will be assessed if the equipment needs cleaning. If the equipment is returned unusable (i.e., returned without a power cord or damaged), Customer is responsible for full retail charges of the equipment.

$20.00 cleaning fee plus tax, required?

Yes:No:

Signature*

Date*

Date

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