TECHNICAL SUPPORT pay my bill GILANETACCOUNTlogin GRTI CALENDAR Residential Application Please Select Type Of Request *New ServiceRe-installRelocate ($50.00)Comp. PurchaseAccount ChangeMove-in date if applicableNote Account Change Reason If Applicable:Primary Account Holder **Required Field (Photo ID Required)Last 4 Digits of Social Security Number **Required FieldPrimary DOB *Drivers Licence Photo Upload *Choose FileNo file chosenDelete uploaded fileSecondary Account Holder*Required Field (Photo ID Required)Last 4 Digits of Social Security Number*Required FieldSecondary DOBDrivers Licence Photo UploadChoose FileNo file chosenDelete uploaded fileContact Name **Required FieldContact Number **Required FieldAlternate Contact Name*Required FieldAlternate Contact Number*Required FieldEmail Address : **Required FieldMAILING ADDRESSApartment, suite, etcCity *State/Province *ZIP / Postal Code *PHYSICAL ADDRESS(include main crossroads, lot number and house number when possible)Apartment, suite, etcCity *State/Province *ZIP / Postal Code *Have you had previous service with GRTI? *YesNoIf yes, under what name?Please select ONE security question *What is your mother’s maiden name?What city were you born in?What is the first school you attended?What is your favorite food?What is your pets name?Please enter your security question answer below: *Create account password *Confirm Account Password *Discount Services - Choose any that apply. If no, leave uncheckedYes, I am 55 years of age or older and feel fabulous! (If yes, you will also need the Elder Concession Form)Yes, I participate in at least one of the programs listed below OR meet the income guidelines.SNAP, Supplemental Security Income, Medicaid, Federal Public Housing, Veterans Pension & Survivors Benefit Program, BIA General Assistance,TANF, Income qualifying Head Start, FDPIR. Income guidelines: Family of 1 - $18,347Family of 2 - $24,719Family of 3 - $31,091Family of 4 - $37,463Family of 5 - $43,835Add $6,372 for each additional family member.GRTI Elderly Concession ApplicationPlease make sure your Name, Address and Phone Number are correct at the top of the form.Do you participate in any of the following programs:Federal Public Housing Assistance/Section 8Supplemental Nutrition Assistance Program (SNAP)MedicaidSupplemental Security Income (SSI)Bureau of Indian Affairs General AssistanceTribally Administered Temporary Assistance for Needy Families (TTANF)Head Start (Income Qualifying/ Residents of Tribal Lands Only)Food Distribution Program on Indian Reservations (FDPIR)Veterans Pension and Survivors Benefit ProgramIncome at or below 135% of the Federal Poverty GuidelinesIncome guidelines:Family of 1 - $18,347Family of 2 - $24,719Family of 3 - $31,091Family of 4 - $37,463Family of 5 - $43,835Add $6,372 for each additional family member. By Signing Below, Customer Certifies the Following: Phone service is listed in his/her name. (One discount per household Can provide identification that verifies they are at least 55 years of age. Customer is responsible for additional charges for Features, Toll & DSL Customer SignatureStart signing your signature hereYour browser does not support e-Signature field.DateInstallation Fees & Phone Purchase$75 one time installation fee - unless you qualify for Enhanced LifelineAdditional Jacks (per hour rate) $45I would like to purchase a phone.Where will jack(s) be installedOPTIONAL Laptop Purchase *NO, I would not like to purchase a laptop.YES, I would like to purchase a laptop! I will pay $300 in fullYES, I would like to purchase a laptop! I will pay $150 and be billed $12.50 for 12 mos.Please indicate how you would like to receive the laptop: *Pick-upDeliverySELECT YOUR SERVICES - Your way is our wayMY LINE *1 phone line (Does not include 911 fee, subscriber line charge, universal service fee, or access recovery - appox. $9) Cost $18.00MY FEATURES *I do not require additional features at this time, thank youAdd unlimited calling features($5.00)Add my choice of 3 calling features($2.00 Each):Add my choice of 3 calling features ($2.00 each):Calling Feature 1--- Choose A Feature ---Anonymous Call RejectionCall ForwardCall HoldCall WaitingCall Waiting w/Caller IDCaller ID – Name & NumberPer Line BlockSelective Call AcceptSelective Call ForwardSelective Call RejectVoice Mail3-Way CallingCalling Feature 2--- Choose A Feature ---Anonymous Call RejectionCall ForwardCall HoldCall WaitingCall Waiting w/Caller IDCaller ID – Name & NumberPer Line BlockSelective Call AcceptSelective Call ForwardSelective Call RejectVoice Mail3-Way CallingCalling Feature 3--- Choose A Feature ---Anonymous Call RejectionCall ForwardCall HoldCall WaitingCall Waiting w/Caller IDCaller ID – Name & NumberPer Line BlockSelective Call AcceptSelective Call ForwardSelective Call RejectVoice Mail3-Way CallingPhone Blocks - No Additional Charge800 Numbers Block - Blocks Direct dial to 800 numbers900 Number Block - Blocks - Direct dial to 900 numbersInternational Block - Blocks Direct dial internationally3rd Party Block - Blocks Charges to your numberLong Distance Block - Direct dial long distanceDirectory Listing Options - Please choose oneNON PUBLISHED Your name and number will not be published or released - $1 PER MONTHUNLISTED Your name and number will not be listed but can be given out by an operator - NO CHARGELISTED Your name and number will be listed in the telephone directory - NO CHARGEHow would you like your name to appear in the directory? Example: John L Smith, J Smith, John & Jane SmithWire Maintenance This covers wiring repairs within your home.Yes Jack repairs and wiring within the home will be covered at this low monthly cost. - Cost $2 PER MONTHNo By selecting no, repairs on wiring within the home will be charged a $45 trip charge. No Monthly ChargeI am aware that if a technician is dispatched to my home for repair and it is determined the issue is due to my personal equipment or wiring, a trip charge of $20 will be billed to my account.MY INTERNET *I do not need high speed internet at this time, thank you. No ChargeI choose 25 Mbps - 1-3 users, Great for streaming with few devices on the internet at once. Cost $27 PER MONTHI choose 50 Mbps - 1-4 users, Medium use for several devices that will use the internet at once. Cost $45 PER MONTHI choose 100 Mbps - +4 users, Best if multiple devices use the internet at once. Cost $55 PER MONTH Please Note: Customers will have to qualify for the indicated speeds, based on service availability by location via fiber. If you do not qualify for these speeds then we will offer you a lower speed available in your service area via copper. Wi-Fi InformationChoose a network name for your home. Example: GRTIHome, this will be viewable to all devices that use the home wi-fi. Now, choose a password to login into the wi-fi don’t share this password with individuals you dont want using your wi-fi. Choose a strong password using uppercase, lowercase, numbers and symbols. Example: #1FrybreadLOV3erWi-Fi Network Name:(8 character’s) network password:E-mail InformationTell us what you would like your e-mail address to be. Choose a password that is 8-16 characters with numbers and letters.1st e-mail preference:Domain must be @gila.netPassword:2nd e-mail preference:Domain must be @gila.netPassword:DSL & Equipment Information - Check your selectionsIs there a working jack by your computer?YesNoIf no, would you like one for $45?YesNoWhat room would you like the jack installed?NOTE:If DSL is disconnected within one year for any reason, you will be billed for the early termination fee of $25.Statement Of Non-DiscriminationGila River Telecommunications, Inc. is the recipient of Federal financial assistance from the U.S. Department of Agriculture (USDA). The USDA prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call toll free (866) 632-9992 (voice) or (800) 877- 8339 (TDD) or (866)377-8642 (relay voice users). USDA is an equal opportunity provider and employer. By signing this application, the undersigned agrees to the rules and regulations of the Gila River Telecommunication, Inc. As set forth in the exchange tariff and on any general changes in the rules, regulations or rates for the service furnished. Upon request the undersigned also agrees to show proof of ownership, rental or lease agreement of the premises in which service, construction and maintenance will be provided. All service lines supplying the undersigned with telecommunications and facilities constructed or installed by the telephone company, on said property, shall at all times be the sole property of the Gila River Telecommunication, Inc. The company shall have the right of access to said property to repair, service and maintain such facilities and upon discontinuance of service for any reason, to remove the same.Do You Agree to the Statement of Non-Discrmination? *YesAcceptable 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. GRTI reserves the right, at our discretion, to update and revise this Policy. Modifications will be effective when posted on our website and are available on our website. Specifically, you may not: Use the Service for any unlawful purpose or in any manner which could damage, disable, overburden, or impair the Alluvion website, our Network or Service(s), or in any other way negatively impact GRTI. Attempt to use or gain unauthorized access to data, accounts, hosts, servers, systems, or networks of others, nor relay communications through any third-party servers without the owner's authorization. Probe, scan, or test the vulnerability of our system or Network, or attempt to access our Network without our prior consent. Interfere with the Service(s) of another, or another's use of Service(s) in any way. Use any forged, false, or misleading number identity, email header, invalid or non-existent domain names in email or postings, nor employ techniques to hide, obscure, or counterfeit the source of e-mail or other posting. Collect or use information without the consent of the owner, or use email addresses, screen names, or other identifiers without the consent of the person identified. Engage in conduct likely to result in retaliation against our website, Network or Service(s), employees, officers, or other agents of GRTI, for example by engaging in behavior that results in any server being the target of a denial-of-service attack (DoS), IP address blacklisting or other similar acts. Post or transmit information or communications that, whether explicitly stated, implied, or suggested through use of symbols, are libelous, defamatory, invasive of another person’s privacy, obscene, indecent, pornographic, sadistic, cruel, or racist in content, or of a sexually explicit or graphic nature, or which espouses, promotes, or incites bigotry, hatred, or racism, or might be legally actionable for any reason, or hurts minors in any way. Configure your use of Service(s) in a manner that prevents 911 from operating properly. Resell Service(s) that are not available for resale. Use the Service(s) to violate email, telemarketing or telecommunication laws or regulations, or in a manner that has a negative effect on our Network or service delivery (including, but without limitation, the use of mass dial or pre-recorded calling applications in violation of law or regulation; overloading servers; violating caller-id regulations; causing any portion of our Network to be blocked by other network providers; generating unresolved third party complaints or complaints which, in our discretion, impose an unreasonable administrative burden on the company; etc.). Additionally, you may not use our Service(s) to upload, post, or otherwise distribute or facilitate distribution of any Content that: Violates the intellectual property rights of any third party. Is unlawful, threatening, abusive, harassing, libelous, defamatory, obscene, deceptive fraudulent, invasive of another's privacy, discriminatory, or tortious. Victimizes, harasses, degrades, or intimidates an individual or group of individuals based on religion, gender, sexual orientation, race, ethnicity, age, disability, or any other reason. Contains viruses, corrupted files, or any other similar software or programs that may damage our Networks or operation of other's computers. Has a negative effect on our business, Network or Service delivery (including, but without limitation, overloading servers; causing any portion of our Network to be blocked by other network providers; generating unresolved third-party complaints or complaints which, in our discretion, impose an unreasonable administrative burden on the company; etc.). Constitutes unsolicited, duplicative, or unauthorized e-mail (commercial or otherwise). Should GRTI receive written notice from a copyright holder that you have infringed on their rights, GRTI will follow the procedures outlined in the notice, which may include suspending or terminating your Service to expeditiously remove or disable access to the infringing material. We reserve the right to take all legal and technical steps available to prevent the foregoing activities from being conducted using the Services, including the right, without prior notice, to monitor content and traffic patterns, perform vulnerability tests on systems residing on our IP address space, or to quarantine servers or Customer accounts if circumstances require. Such testing may include, but is not limited to, testing of mail and Internet servers or proxy servers for unrestricted third-party relaying. We will use commercially reasonable efforts to ensure that such testing will not adversely affect Services or compromise service performance or the security of the Network. Customers may be required to correct any system vulnerability upon notification and/or suspend or terminate operations of a known compromised system. Any failure by us to enforce this Policy in every instance in which it might have application does not amount to a waiver of our rights.Do You Agree to The Acceptable Use Policy? *YesRight-of-Entry PermissionThe following Consent by 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? *YesCustomer Signature *Start signing your signature hereYour browser does not support e-Signature field.Date * SUBMIT