Residential: Request Fiber Internet Service We will consider a submitted form as intent to start the installation process. Residential: Request Fiber Internet Service First Name * Last Name * Address * Address Address Address Address Mississippi Mississippi Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Mississippi Address Cell Phone * Home (Secondary) Phone Email * Monroe County EPA Account Number Please Select How You Would Like to be Contacted: (Check All That Apply) * Text Message Email Phone Cell M-PULSE Fiber Internet options (Check only one) * MEGA-PULSE 100 Mbps – $55.00 GIGA-PULSE 1 Gbps – $85.00 ** Managed Wi-Fi Service Included in Above Prices ** Would You like to sign up for phone service from M-PULSE Fiber? Yes No M-PULSE Phone options (Check only one) Keep my existing Phone Number Give me a New Phone Number Phone Line Options (Check All That Apply) First Phone Line – $29.95 Additional Phone Lines – $24.95 each (enter number in field)Additional Phone Lines – $24.95 each (enter number in field) Existing Phone Number Please Read and Check Where Applicable: I AGREE TO RECEIVE AN E-BILL STATEMENT (VIA THE SAME EMAIL ADDRESS IN THIS FORM) AND NOT A PAPER BILL. I WOULD LIKE TO SIGN UP FOR AUTOMATIC BANK DRAFT FOR M-PULSE FIBER USING THE SAME BANK ACCOUNT INFORMATION ALREADY BEING USED FOR MONROE COUNTY ELECTRIC POWER ASSOCIATION. I AGREE TO SIGN UP FOR AUTOPAY USING BANK DRAFT. (SEE ATTACHED FORM) Bank Draft Form Must Agree to the Following * I AGREE TO NOTIFY M-PULSE FIBER IF ANYONE IN THE RESIDENCE IS DIAGNOSED WITH COVID-19. I CONFIRM I AM THE OWNER OF THE PROPERTY WHERE SERVICE IS BEING REQUESTED OR HAVE THE PERMISSION FROM THE PROPERTY OWNER. I HAVE RECEIVED A COPY AND AGREE TO THE SERVICE APPLICATION/AGREEMENT WITH GENERAL TERMS AND CONDITIONS. Terms and Conditions Submit If you are human, leave this field blank.