Services - Sign-up Form

Sign-up Form Instructions

The first step in getting High Speed Internet Service form Hoosier Internet is to sign up.

Once submitted, your location will be added into our Site Survey queue, and we will send a technician onsite to review your location for our High Speed service.

There is no cost or obligation for the site survey. Once your location is confirmed by our survey crew, we will contact you to schedule an installation day and time.

Please fill out our online sign up form below and start the process to getting you online with High Speed Internet service from Hoosier Internet.

 

Contact Information

First Name * Last Name * Home Address * City * Francesville Medaryville Monon Winimac Rensselaer Zip Code *
Email *(if you have one)
Daytime Phone Number * Cell Phone Number

Memo

Please include any special instructions or information that may be needed.

Type of Installation

Please Choose Free if I pay 1st 6 months in advanced ($239.94) I want to pay 1 month + install ($189.98)

2+2=?input answer

Click “Submit” below!