Baycreek Communications

Bay Creek Communications
107 Mason Ave.,
Cape Charles,
VA 23310
Tel: 757-331-8700
Fax:757-331-8719

Service Application

Name:
Community:
Address:
Day Phone:
Alternate Phone:
Billing Address:	check if same as service address
Address:
City:
State:
Zip:
CABLE TV SERVICES
Check one:	Basic Cable Extended Cable
Check all desired:	Cinemax HBO Starz/Encore HBO/Cinemax Combo Showtime/TMC
*Important!* The unit attached to the home contains 90 volts and must not be tampered with. Bay Creek Communications is not responsible for any damage if the unit has been tampered with.
INTERNET SERVICES
Select:	High Speed Internet
Cable Modem (required) - Available for rent or purchase from Bay Creek Communications
Cable Modem Rental $10/month or,	Yes No
Purchase cable modem from Bay Creek Communications?	Yes No
Router (recommended) - Available for purchase from Bay Creek Communications
Purchase router from Bay Creek Communications?	Yes No
Please check one:	Self-installation Professional Installation Network Installation Wireless Installation
If you already have a modem please provide the following;
Modem Mac Address:
Modem Serial Number:
Email Addresses requested:	@ baycrk.net
	@ baycrk.net
	@ baycrk.net
	@ baycrk.net
User Agreement: By signing below, you agree to the terms of the Internet Service Agreement set forth and given to you by Bay Creek Communications.

Bay Creek Communications - 107 Mason Ave., Cape Charles, VA 23310 - Tel: 757-331-8700 | Fax: 757-331-8719