TECHNICAL SUPPORT pay my bill GILANETACCOUNTlogin GRTI CALENDAR BUSINESS Application Click below and fill out Business Application below. If you need assistance you may call (520) 796-8800. Business Name *DateBILLING ADDRESSApartment, suite, etcCityState/ProvinceZIP / Postal CodeSERVICE ADDRESSApartment, suite, etcCityState/ProvinceZIP / Postal CodeLOCAL CONTACT PERSON *Local Contact Number *Local Contact Email *Applicant/Corporate Contact Person *Applicant/Corporate Contact NumberApplicant/Corporate Contact EmailEmail Address for Status Report NotificationsDirectory ListingUnlistedNon-Published($1)ListedName to be listed in directoryBusiness DSL Bundles - DSL bundles include a phone line.Installations Fees: DSL - $250.00 NRC, Phone - $125.00 NRC - DSL installation fee waived with 12 month agreement25 Mbps w/ 3 Mbps upload - $99.00 MRC50 Mbps w/ 10 Mbps upload - $115.00 MRC100 Mbps w/ 50 Mbps upload - $175.00 MRC250 Mbps w/ 75 Mbps upload - $250.00 MRC500 Mbps w/ 100 Mbps upload - $325.00 MRC1 Gbps w/ 500 Mbps upload - $450.00 MRCPlease check desired service(s)Dedicated Ethernet ConnectionSingle Static IPPRI T1Static IP BlockPhone Line Options - Please indicate the amount of each type of line.PhoneNumber of Phone LinesFaxNumber of Fax LinesFireNumber of Fire LinesLong Distance Carrier (Unless otherwise specified, your choice will apply to both Inter/Intralata)Gila River 6841Other LD Carrier, Please Specify (carrier and pic code):Additional Details, Requests & NotesBUSINESS ACCOUNT AUTHORIZATIONAuthorization:Please list the names of all employees that are authorized to inquire and/or make changes to this account, either in person or over the phone.Authorized 1 NameAuthorized 1 TitleAuthorized 1 Work PhoneAuthorized 1 Cell PhoneAuthorized 2 NameAuthorized 2 TitleAuthorized 2 Work PhoneAuthorized 2 Cell PhoneAuthorized 3 NameAuthorized 3 TitleAuthorized 3 Work PhoneAuthorized 3 Cell PhoneAuthorized 4 NameAuthorized 4 TitleAuthorized 4 Work PhoneAuthorized 4 Cell PhoneAuthorized 5 NameAuthorized 5 TitleAuthorized 5 Work PhoneAuthorized 5 Cell PhoneAuthorized 6 NameAuthorized 6 TitleAuthorized 6 Work PhoneAuthorized 6 Cell PhoneUPLOAD OTHER DOCUMENTSDrag and Drop (or) Choose FilesAcceptable Use PolicyThis Acceptable Use Policy (“Policy”) applies to your use of and access to the Gila River Telecommunications Inc. (“GRTI”) owned or operated networks (“Network”), including electronic transmissions sent, received, posted, accessed, or stored via these Networks including, but without limitation, data, voice, and messaging services, and Internet services (collectively the “Service”). By using the Service, you agree to comply with this Policy. Your use of the Service(s) may be suspended or terminated for violation of this Policy.Do You Agree to The Acceptable Use Policy? *YesRight-of-Entry PermissionThe following Consent by the landowner grants permission to Gila River Telecommunications Inc. (GRTI) employees and it’s subcontractors to enter the property to plan and install Telecommunications Services per the application filled out by the above named landowner. The undersigned hereby grants Permission to Gila River Telecommunications Inc. to enter the premises as described.Do You Agree to the Right-of-Entry Permission? *YesPlease Note:If this form is not returned to GRTI we will assume anyone calling is authorized.Authorized Persons Printed NameDate SUBMIT
