Service Application - Lynxx Networks

Lynxx Service Application

Thank you for choosing Lynxx Networks! Please complete this application for service. If you are unsure if we service your address, please call us at (608)427-6515. A Customer Technology Consultant will reach out upon submission of your application to confirm services, bill estimate and schedule installation. This form is not binding and we will not ask for any financial information. This will be used to set up your account upon confirmation from a Customer Technology Consultant.

Do you qualify for financial assistance? Click here for: Lifeline and ACP information

First Name First Name is required.

Last Name Last Name is required.

Service Address Service Address is required.

City City is required.

City/Township Country/Township is required.

Zip Code Zip Code is required.

County County is required.

Phone Phone is required.

Email Email is required.

Billing Address (if different from service address)

City

Billing Address Zip Code

Birth Date Birth Date is required.

Drivers License or State ID Number Drivers License or State ID Number is required.

How did you hear about us?

Billboard

Social Media

Event

Referral

Direct Mailer

Search Engine (ie. Google, Bing, Edge)

Who referred you?

Are you currently working with a Customer Technology Consultant? If yes, please list them here:

Do you rent or own your home?

Rent

Own

Additional User Name

Birth Date

Customer Proprietary Network Information (CPNI)

The protection of your account information has always been very important to us, so has the opportunity to provide you with excellent customer service. In order to continue providing you with this level of service, we ask that you read the following information carefully, as the Federal Communication Commission (FCC) has imposed these rules on all telecommunications providers. These rules will require that we obtain verification from you before we can provide you any information on your billing account. Following are the FCC rules:  Customers requesting information in person will be required to provide a photo ID; Customers requesting information over the phone will be required to provide us with the account password (see below for establishing a password for your account). If a password is forgotten the customer will have established a “verification question” and “answer” that will allow us to provide or reset the forgotten password. Customers not able to provide the required verification, will only be allowed to receive their account information through the mail. The information may only be sent to the address on the customer account. Lemonweir (Lynxx) encourages customers to make any name changes to their account that would make account access easier for those who need to inquire about the account. For example, adding the other spouse’s name if the account is listed in only one spouse’s name. For this process, our company will waive the one-time charge that is normally charged for name changes.

Please choose a security question for your account.

Enter the answer to your security question here.

Please assign a password for your account

A password will be used to make changes to your account.

Please assign a 4 digit PIN number for your

This PIN number will be required for making phone payments.

Enroll in electronic billing and/or autopay.

Electronic billing only

Autopay only

Electronic billing and autopay

No thank you, please send my bill in the mail.

If you choose electronic billing and/or autopay, we will send you a form to authorize the monthly payments. The $5 monthly credit is only available when payments are made from a checking or savings account.

Enroll in electronic billing and/or autopay. is required.

How do you prefer us to contact you for appointment reminders, cost saving options and account alerts? You may select multiple.

Phone

E-mail

Text messaging (must include your cell phone number on this application)

How do you prefer us to contact you for appointment reminders, cost saving options and account alerts? You may select multiple. is required.

Please add any comments here.

I have read and understand the Policies, Terms and Conditions.

Yes

I have read and understand the Policies, Terms and Conditions. is required.

Click to read the Terms and Conditions.

Signature Signature is required.