Vacation Hold Form

Temporary Disconnect Form (Vacation Hold)
Note: If Red Bolt service is disconnected for longer than 6 months, you will be charged a $50 reconnect fee, plus tax, upon reactivation. Only one (1) vacation hold is allowed per calendar year.
Customer Name*
Red Bolt Account Number
Service Address*
Phone*
Email Address*
example@example.com
Vacation Start Date*

MonthDayYear
Date
Vacation End Date (if known)

MonthDayYear
Date
Forwarding Mailing Address (in case we need to reach you about your account):
Equipment Information (Customer will be assessed the monthly rental fee for equipment not returned.)*

Router will not be returned during vacation hold.Router returned.
By signing this form, I understand I am still responsible for any unpaid bill or past due amounts owed. If I do not return a router, or other rental equipment while on vacation hold, I will be assessed the monthly rental fee plus taxes for all equipment.

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.
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:

Temporary Disconnect Form (Vacation Hold)