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.

First Name is required.
Last Name is required.
Service Address is required.
City is required.
Country/Township is required.
Zip Code is required.
County is required.
Phone is required.
Email is required.
Birth Date is required.
Drivers License or State ID Number is required.
A password will be used to make changes to your account.
A password will be used to make changes to your account.
This PIN number will be required for making phone payments.
This PIN number will be required for making phone payments.
Router rental includes 24/7 tech support.
Router rental includes 24/7 tech support.
*Domestic area includes Continental US, Alaska, Hawaii, Canada, US Virgin Islands and Puerto Rico.
*Domestic area includes Continental US, Alaska, Hawaii, Canada, US Virgin Islands and Puerto Rico.
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.
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.
How do you prefer us to contact you for appointment reminders, cost saving options and account alerts? You may select multiple. is required.
I have read and understand the Policies, Terms and Conditions. is required.
Signature is required.