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Installation Request for ADSL Name: email address: ADSL Phone #: Contact Phone#: Address: Change current line to ADSL Install New ADSL Line Change Tier Of Service Switch ADSL service from another provider To Modem Madness Tier of Service Requested Tier 1-128k up/768k down Alltell Charges: $29.95 per month (plus current line charge) $99.95 installation fee Modem Madness Charges: $19.95 per month Tier 2-256k up/1536k down Alltell Charges: $59.95 per month (plus current line charge) $99.95 installation fee Modem Madness Charges: $39.95 per month Tier 3-768k up/1536k down Alltell Charges: $119.95 per month (plus current line charge) $99.95 installation fee Modem Madness Charges: $69.95 per month Efficient Speedstream 5660 Router form of payment 1 payment of $250 1 Year Alltel contract $99.95, no installation fee 2 Year Alltel contract No Router Fee, No Installation Fee

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