Application for Residential Internet/Phone Service...1 P.O. Box 196, Waverly, VA 23890 Application for Residential Internet/Phone Service For Internet Service at: Applications for

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P.O. Box 196, Waverly, VA 23890

Application for Residential Internet/Phone Service

For Internet Service at:

Applications for Internet/Phone service must be in the same name(s) as member’s electric service (where applicable).

Applicant Information

Name:

Mailing Address: (If different from Service Address)

Email:

Phone: Last 4 digits of SSN:

Place of Employment:

Work Address: Work Phone:

Joint Applicant Information

Name:

Mailing Address: (If different from Service Address)

Email:

Phone: Last 4 digits of SSN:

Place of Employment:

Work Address: Work Phone:

If renting this property, please provide owner’s information below:

Owner Name: Owner Phone:

Owner Address:

The undersigned Applicant/Joint Applicant hereby apply for Internet Services (and Phone Services if enrolled) by RURALBAND and agree to be bound by the attached Internet/Phone Service Terms and Conditions and the following provisions:1. Initial $75.00 non-refundable processing fee and $100.00 installation fee will be paid to RURALBAND upon first billing cycle after connection.2. Upon approval of Application for Internet/Phone Service by RURALBAND, Applicant/Joint Applicant agree to take speed of Internet/Phone Service

as indicated on tiered Internet Service Plan document for the term of one calendar year from service initiation date, at the corresponding monthlyrate. A Wi-Fi router will be furnished by RURALBAND. Applicable state and local taxes, and additional installation fees may apply. Router shallremain the property of RURALBAND and shall be returned to the Company upon termination of service. Early termination fees will be billed themonthly service rate per month for the remaining number of months left in the contract. Early termination fees will not exceed the remainder of theterm of service multiplied by the level of service selected in this application. Router equipment not returned to RURALBAND upon early terminationor for service discontinued after the contractual term of this agreement will be billed $250.00 dollars. If router equipment is damaged upon return toRURALBAND, a damage cost of $250.00 dollars will be assessed.

3. Applicant/Joint Applicant agree to be bound to RURALBAND Internet/Phone Application Terms and Conditions, and such rules and regulations asmay be adopted from time to time by RURALBAND.

4. Applicant/Joint Applicant hereby authorize RURALBAND to obtain reports of Applicant’s/Joint Applicant’s record with any credit reporting agenciesor other organizations extending credit to Applicant/Joint Applicant for verification of any data requested of Applicant/Joint Applicant to be used byRURALBAND for any purposes required for carrying out the terms of this agreement.

By initialing, Applicant/Joint Applicant authorize RURALBAND to contact me/us for informational purposes or for solicitation of products

or services by means of automated dialing notifications. __________ / __________ (Initial)

Revised 6/25/2020

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P.O. Box 196, Waverly, VA 23890

Internet/Phone Service Application Terms and Conditions

Applicant/Joint Applicant agree to be bound by Internet/Phone Service Application and Terms and Conditions of RURALBAND (‘Company’) as follows:

1. CURRENT MINIMUM PAYMENT TERMS UPON APPROVAL OF APPLICATION FOR INTERNET/PHONE SERVICE BY RURALBAND. Applicant/Joint Applicant agree to pay for all services provided by RURALBAND, including, but not limited to, charges for installation, equipment, services, andall applicable local, state or federal fees, taxes and surcharges. The term for service begins upon installation of service and connection OR change indata speed package to Applicant’s/Joint Applicant’s device(s). Monthly billing for Internet/Phone Service will be in advance of receiving service.Charges for service billed are due no later than the 20th day of each month. Any unpaid balance as of the 1st day of the following month may result indisconnection of service. There will be a $10.00 service reinstatement fee for reconnection due to service interruption for nonpayment. Any unpaidbalance will be assessed a monthly 1.5% late fee. Accounts disconnected for nonpayment will be reconnected the following business day after theunpaid balance is paid.

2. TRANSFER OF ACCOUNT/CHANGE OF RESIDENCE. The Internet/Phone Service applied for shall be furnished at the address of installationONLY. Applicant’s/Joint Applicant’s rights and obligations to the Internet/Phone Service are NOT ASSIGNABLE.

3. ACCESS ON PREMISES. Applicant/Joint Applicant grants RURALBAND, without charge, an easement to, over, under and across property to construct,install, maintain, connect, reconnect, inspect, upgrade, extend, expand, remove and/or replace fiber lines, equipment, material and infrastructure,including, but not limited to, poles, wires, anchors, guys, cross arms, fiber optic cables, above ground pedestals and other necessary appurtenances. Theeasement hereby granted to RURALBAND shall include the right to attach wiring and equipment to structures.Upon installation of Internet/Phone Service by RURALBAND, RURALBAND shall have the right of access to enter upon Applicant’s/Joint Applicant’spremises at all reasonable times for the purpose of maintaining, testing, removing its wiring, equipment and other property. In the event such access isat any time denied to RURALBAND, its agents, representatives or employees, RURALBAND shall have the right to discontinue Internet/PhoneService to the premises without notice.

4. WARRANTY DISCLAIMER: LIMITATION OF LIABILITY. RURALBAND INTERNET/PHONE SERVICE IS PROVIDED UNDER THE TERMS OF THISAPPLICATION ON AN “AS IS” AND “AS AVAILABLE” BASIS WITHOUT WARRANTIES OF ANY KIND, EITHER EXPRESSED OR IMPLIED.RURALBAND AND ITS SUPPLIERS MAKE NO WARRANTIES ABOUT THE SERVICE PROVIDED HEREUNDER, EXPRESS OR IMPLIED,INCLUDING, BUT NOT LIMITED TO, ANY WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. RURALBAND ANDITS SUPPLIERS DO NOT AUTHORIZE ANYONE TO MAKE A WARRANTY ON RURALBAND’S BEHALF AND THE CUSTOMER MAY NOT RELY ONANY STATEMENT OF WARRANTY AS A WARRANTY OF RURALBAND AND ITS SUPPLIERS. THE WARRANTY SET FORTH IN THIS SECTION ISTHE SOLE AND EXCLUSIVE WARRANTY PERTAINING TO ANY SERVICES OR EQUIPMENT SOLD BY RURALBAND HEREUNDER, ANDRURALBAND AND ITS SUPPLIERS MAKE NO OTHER WARRANTIES, REPRESENTATIONS OR GUARANTEES WITH RESPECT THERETO. THIRDPARTY PRODUCED ITEMS ARE PROVIDED AS IS AND WITHOUT WARRANTY. IN NO EVENT SHALL RURALBAND AND ITS SUPPLIERS (OR ITSAFFILIATES, EMPLOYEES, OFFICERS, DIRECTORS OR AGENTS) BE LIABLE TO THE CUSTOMER FOR ANY INDIRECT, SPECIAL, INCIDENTAL,CONSEQUENTIAL OR EXEMPLARY DAMAGES, INCLUDING, WITHOUT LIMITATION, DAMAGES FOR LOSS OF REVENUE, LOSS OF PROFITS,OR LOSS OF CUSTOMERS, CLIENTS OR GOODWILL ARISING IN ANY MANNER FROM THE AGREEMENT AND/OR THE PERFORMANCE ORNONPERFORMANCE HEREUNDER, EVEN IF SUCH PARTY HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES OR DAMAGES, ANDREGARDLESS OF THE NATURE OF THE CLAIM OR FORM OF ACTION, WHETHER IN CONTRACT OR TORT INCLUDING NEGLIGENCE.RURALBAND’S ENTIRE LIABILITY AND CUSTOMER’S EXCLUSIVE REMEDIES WITH RESPECT TO ANY SERVICE PROVIDED TO CUSTOMER(INCLUDING WITHOUT LIMITATION WITH RESPECT TO THE INSTALLATION, DELAY, PROVISION, TERMINATION, MAINTENANCE, REPAIR,INTERRUPTION, OR RESTORATION OF ANY SUCH SERVICE) OR BREACH OF THE AGREEMENT, WHETHER IN AN ACTION FOR OR ARISINGOUT OF BREACH OF CONTRACT, TORT, INCLUDING NEGLIGENCE, INDEMNITY OR STRICT LIABILITY, SHALL BE LIMITED TO A MAXIMUM OFA TOTAL AMOUNT OF ALL FEES PAID BY CUSTOMER TO RURALBAND IN THE MOST RECENT THREE MONTH PERIOD HEREUNDER. THEPROVISIONS OF THIS SECTION CONSTITUTE AN ALLOCATION OF RISK BETWEEN THE PARTIES AND THE PRICE CHARGED CUSTOMER ISBASED ON SUCH ALLOCATION OF RISK. THE TERMS OF THIS SECTION SHALL SURVIVE THE FAILURE OF AN EXCLUSIVE OR LIMITEDREMEDY OR THE TERMINATION OF THIS AGREEMENT FOR ANY REASON. THIS SECTION SURVIVES TERMINATION OF THE AGREEMENT.

5. APPLICANT/JOINT APPLICANT INDEMNIFICATION. Applicant/Joint Applicant shall be responsible for and shall defend, indemnify, and hold harmlessRURALBAND and its employees, affiliates, suppliers, agents and contractors, and shall reimburse RURALBAND for any damages, losses, orexpenses, including, without limitation, reasonable attorney’s fees and costs incurred by RURALBAND, in connection with any claims, suits, judgmentsand causes of action arising out of (i) Applicant’s/Joint Applicant’s use of Internet Service and equipment; (ii) violation or infringement of contractualrights, privacy, confidentiality, copy-right, patent, trademark, trade secret or other intellectual property and proprietary rights arising from use of theInternet Service or any unauthorized apparatus system; and (iii) Applicant’s/Joint Applicant’s breach of any provision of this application. Please be awarethat terms and conditions are subject to change.

6. SERVICE INTERRUPTIONS. RURALBAND assumes no liability for interruption of Internet/Phone Service or alterations in programming due tocircumstances beyond its control, including, without limitation, acts of God, natural disaster, fire, civil disturbance, strike or weather. RURALBANDassumes no liability for any substitution, discontinuation or modification of any programming. RURALBAND will restore Internet/Phone Service within areasonable time after a reported Internet/Phone Service interruption.

7. APPLICANT/JOINT APPLICANT WIRING CERTIFICATION. Prior to RURALBAND installing and providing Internet/Phone Service, Applicant/JointApplicant certify that the wiring of the premises to which RURALBAND will provide Internet/Phone Service has been installed according to all federal,state and local regulations.

8. POWER REQUIREMENTS. The Applicant/Joint Applicant understands and acknowledge that the furnished fiber optic Internet Service requireselectricity at the Applicant's/Joint Applicant’s Internet Service location, and if an electrical service outage occurs, the fiber optic Internet Service, whichcould include telephone service, will not function during the outage period.

Revised 6/25/2020

P.O. Box 196, Waverly, VA 23890

3

9. APPLICANT/JOINT APPLICANT WARRANTIES. By signing this application for Internet/Phone Service, including, but not limited to, high speed data,video or phone (individually and collectively "services") delivered by RURALBAND, we acknowledge that we are at least 18 years of age and legallycompetent and authorized to agree to these terms and conditions of service.

10. CUSTOMER RESPONSIBILITIES. In addition to all other Customer responsibilities as set forth in the Agreement, Customer shall be responsible forproviding the following: (i) broadband Internet connectivity; (ii) all equipment, software, facilities and/or Internet Protocol (“IP”) connectivity necessary toreach and interoperate with the Service and the RURALBAND network; and (iii) all other equipment, software and other facilities to be installed,including without limitation, routers, IP enabled phones and/or an analog terminal adapters.

11. DISPUTES. Any dispute regarding Services must be submitted in a timely manner. The dispute notice shall set forth in writing in reasonable detailthe information concerning the disputed charges and reasons for the dispute. RURALBAND and Customer shall attempt in good faith to promptlyresolve any objection to the invoiced amount. If the dispute is subsequently resolved in favor of Customer, RURALBAND shall issue a credit onCustomer’s subsequent invoice for the disputed amount. If RURALBAND initiates legal proceedings to collect any amount due hereunder andRURALBAND substantially prevails in such proceedings, then Customer shall pay the reasonable attorneys' fees and costs incurred by RURALBANDin prosecuting such proceedings and any appeals therefrom. In the event Customer fails to pay any invoice when due, or provide RURALBAND with anotice of dispute, RURALBAND shall notify Customer regarding its failure to pay such invoice. If after RURALBAND has provided such notice,Customer continues to fail to pay such invoice(s) after such notice, RURALBAND may, in addition to any other rights and remedies available toRURALBAND, suspend service under this Agreement until all outstanding invoice(s) are paid in full. In addition, in such case RURALBAND may electto terminate this Agreement, and shall be entitled to seek and exercise such rights and remedies that may other wise be permitted hereunder or at lawor in equity.

12. UNAUTHORIZED USE OF SERVICES. RURALBAND shall have the right (but not the obligation) to take protective action against Customer in orderto protect RURALBAND’s network from any unauthorized use, which protective action may include, without limitation, the temporary blocking ofCustomer’s traffic until the applicable problem is resolved (in RURALBAND’s reasonable discretion. The Service does not support and RURALBANDwill not accept 976/900 and such other call types in which charges are placed on an end-users bill and RURALBAND might be expected to act as acollection agent. Use of predictive dialers for more than five percent (5%) of all calls made is prohibited with RURALBAND’s written consent. See theAcceptable Use Policy at https://ruralband.coop/. By using these Services, you agree to be bound by the terms of this Policy.

13. CUSTOMER PROPRIETARY NETWORK INFORMATION (CPNI) Under federal law, Customer has the right, and RURALBAND has a duty, to protectthe confidentiality of information about the amount, type, and destination of Customer’s service usage (CPNI). Customer hereby consents to thesharing of Customer’s CPNI or other personal information with RURALBAND, Inc. and its affiliates, agents and contractors, solely for the purpose ofdeveloping or bringing to Customer’s attention any products and services, or in the event of any merger, sale of some or all of the company assets oracquisition as well as in any insolvency, bankruptcy or receivership proceeding in which CPNI or other personal information would be transferred asone of the business assets of the company. This consent survives the termination of Customer’s Service and is valid until revoked by Customer. Toremove this consent at any time, Customer must notify RURALBAND in writing at 7103 General Mahone Highway PO BOX 196, Waverly, VA 23890Attn: Customer Service and provide the following information: (1) Customer name, (2) Service billing address, (3) telephone number including areacode, and (4) service account number. Removing consent will not affect the Customer’s current Service.

14. CONSENT TO USE ELECTRONIC SIGNATURES AND RECORDS For your convenience, RURALBAND provides access to its Service online. Thismay require you to enter into agreements or receive notices electronically. As a result, you acknowledge and agree that by clicking “I Agree” or “IAccept”, you agree to conduct electronically without limitation the particular transaction into which you entered including entering into this Agreement;

a. You have read and understand the electronic copy of electronic contracts, notices and records, without limitation including this Agreement,and any policies and any amendments;

b. You agree to, and intend to be bound by, the terms of the particular transaction into which you thereby enter;c. You are capable of printing or storing a copy of electronic records of transactions into which you enter including, without limitation, this

Agreement and any amendments hereto; and,d. You agree to receive electronically information about the Service and other electronic records into which you thereby enter including, without

limitation, this Agreement.

15. PGEC will charge for service appointments when the source of your service problem is not RURALBAND-owned facilities or equipment provided toyou by PGEC Enterprises. The member may be assessed a $65.00 per hour charge if the technician conducting the visit determines applicablecharges are appropriate based on the technical findings. RURALBAND will try to resolve member concerns primarily with phone technical support priorto any scheduled visits to minimize the costs to our members.

*Terms and conditions are subject to change.

Revised 6/25/2020

Please choose your monthly Internet/Phone Service Package by checking the box below.

$74/month - Basic - Up to 100MB $139/month - Professional with IP Address - Up to 1GB

Signature: Date: Applicant

Signature: Date: Joint Applicant

INTERNET $49/month - Entry Level - Up to 25MB

PHONE

$99/month - Gamer with IP Address - Up to 250MB

No Phone Service Add Phone Service to any Internet Package above-$11/month Phone Only-$38/month

RURALBAND Use:

Connection Date: ___/___/_____ Activation Fee: _______

Current Member #: ___________________________________ Customer Number: ___________________________________

Account #: ___________________________________ Service Order #: ___________________________________

Level of Internet/Phone Service Selected: ___________________________________

This application for Internet/Phone Service is accepted by RURALBAND:

Date: ___/___/_____ By______________________________________________ RURALBAND Representative

4Revised 6/25/2020

5

P.O. Box 196, Waverly, VA 23890

Release of Liability for Damage

For Internet/Phone Service at:

Owner Information

Name:

Mailing Address:

Email: Phone:

RURALBAND strives to plan, construct, and complete all construction projects without damage to its customer's property. However, it is inherent in the construction process that conditions and unknown circumstances may result in some unintended damages. Property damage may also result from soil conditions, weather conditions and site conditions caused by others. It will be the property owner’s responsibility to repair any damages that may occur during the construction or maintenance of Internet/Phone services. The property owner releases from liability and holds harmless RURALBAND and/or any designated third-party contractors, from any responsibility whatsoever, for property damage in the course of construction or installation of Internet/Phone services. This does not release RURALBAND from responsibility for acts of negligence.

➢ Responsibilities of the property owner:

✓ Must mark outer boundaries of a septic tank and a drain field which would be within 50 feet of the area RURALBAND must

construct facilities or mobilize equipment.

✓ Must expose any private underground facilities which are within 4 feet of the route planned for the installation of underground

cable/fiber or any other equipment.

✓ Must fill settled trenches or make any other repairs necessary in the area where RURALBAND constructed facilities to make it safe;

for example: fill trenches to prevent a stumbling hazard.

➢ Damages may include but are not limited to:

✓ Property or premises while

▪ Constructing overhead or underground Internet/Phone services

▪ Penetrating of structures for the routing of Internet/Phone cable

✓ Landscape

• Settling of earth in trenches and around poles

• Ruts from the movements of heavy utility vehicles

• Erosion due to disturbed earth

✓ Driveways/Sidewalks

• Cracking of asphalt or concreate due to equipment movements

• Rutting of dirt or gravel driveways due to equipment movements

✓ Private buried facilities

• Septic systems

• Underground lines of any kind: well, drain, electric, irrigation

✓ Personal injury that may occur as a result of soil or other conditions in the area where there was construction or maintenance of

underground or overhead Internet/Phone services by RURALBAND.

Signature: Date: Property Owner

Revised 6/25/2020

6

P.O. Box 196, Waverly, VA 23890

Landlord Release and Continuance for Internet/Phone Services

For Internet/Phone Service at:

Owner Information

Name:

Mailing Address:

Email: Phone:

Owner acknowledges legal ownership of the premises having the street address above for which Internet/Phone Service to be provided by RURALBAND. For the purpose of allowing RURALBAND to provide such Internet Service at the foregoing address and for the purpose of granting the easements for access to the premises for installation, including the right to attach wiring and equipment to structures, maintenance and removal of Internet/Phone Service, Owner, executes this Landlord Release and Continuance for Internet/Phone Services.

This agreement shall remain in effect and shall not be required as part of future tenant applications for Internet/Phone Services provided by RURALBAND.

Signature: Date: Property Owner

Revised 6/25/2020

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