Skip to main content
Sign In
Register
myMaxxSouth
Sign In
or
Register
Residential Utility
For Business Service
Order Online
Residential Main Navigation
Shop
Image
Shop All Offers
Image
Artboard 1
Retail Locations
Image
Upgrade Offers
Image
Shop MaxxMobile
High-speed Internet
Image
Internet Offers
Image
Fiber Internet
Image
SmartNet
HD Cable TV
Image
DIGITAL/HD CABLE TV
Image
MAXXSOUTH TV EVERYWHERE
Image
MaxxSouthTV
Image
MaxxSouth Sports
Other Services
Image
Digital Home Phone
Image
MaxxMobile Plans
Image
Brainiacs
Image
Artboard 1
MaxxSouth Broadband Business
Image
MaxxSouth Broadband Media Sales
Support
Image
Artboard 1
Retail Locations
Image
Moving? Switch My Service
Image
Support Center
Image
Test Your Speed
Image
Community First
Image
Talk to an Expert
Current Customers
Image
Online Bill Pay
Image
765CCCAD-0E00-442E-B32C-C144B476B2FA
Created with sketchtool.
Layer 1
Email Account
Image
Phone Account
Image
Rewards
Image
Refer and Earn
Image
myMaxxSouth App
This is a Presale Order
This is a Fiber Conversion
Order Date
Install Date Requested
Install Time Requested
AM (8-11)
Noon (11-2)
PM (2-5)
All Day (8-5)
Subscriber Name
First
Last
Suffix
Date of Birth
Social Security Number
Drivers License Number
State Issued
State/Province
- None -
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces (Canada, Europe, Africa, or Middle East)
Armed Forces Americas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Expiration Date
Home Phone
Cell Phone
Service Address
Address
Address 2
City/Town
State/Province
- None -
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces (Canada, Europe, Africa, or Middle East)
Armed Forces Americas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
ZIP/Postal Code
Mailing address is the same as the service address.
Mailing Address
Address
Address 2
City/Town
State/Province
- None -
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces (Canada, Europe, Africa, or Middle East)
Armed Forces Americas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
ZIP/Postal Code
Email
Is this customer eligible for MaxxFiber services?
- Select -
Yes
No
RSC Only Offers
SP: TiVo+ & Starter Internet
$39.99
StreamTV Basic, TiVo+ & Essential Internet
$89.99
StreamTV Expanded Basic, TiVo+ & Essential Internet
$149.99
Streaming Services
StreamTV Basic
StreamTV Expanded Basic
TiVo+
How many StreamTV boxes are needed?
Channel Guide Free for One Month!
Channel Add-Ons
Digital Basic
Digital Plus
HBO
Includes access to Max!
Paramount+ with Showtime
Cinemax
Starz/Encore
MGM+
High-Speed Internet Options
Starter Internet
150 Mbps Download/5 Mbps Upload
Essential Internet
400 Mbps Download/10 Mbps Upload
Ultimate Internet
600 Mbps Download/12Mbps Upload
Supreme Internet
1000 Mbps Download/20 Mbps Upload
Additional Services
SmartNet
Service Assurance Plan
Brainiacs
Only $5 if added with SAP
BARK Jr.
Free Parental Controls App when signing up for MaxxFiber!
BARK Premium
WTFast Single
WTFast Family
Digital Home Phone Service
- None -
Yes
No
CPNI
?
Phone Number Options
Hosted Number
Ported Number
Number to Port
Do you want your phone number listed?
Yes
No
Additional Phone Lines Needed
Number of Beacons Needed
RSC Only Offers
SP: TiVo+ & Fiber 200
$39.99
StreamTV Basic, TiVo+ & Fiber 400
$89.99
StreamTV Expanded Basic, TiVo+ & Fiber 400
$149.99
Streaming Services
StreamTV Basic
StreamTV Expanded Basic
TiVo+
How many StreamTV boxes are needed?
Channel Guide Free for One Month!
Channel Add-Ons
Digital Basic
Digital Plus
HBO
Includes access to Max!
Paramount+ with Showtime
Cinemax
Starz/Encore
MGM+
None of the above
MaxxFiber Options
Fiber 200
200 Mbps Download/200 Mbps Upload
Fiber 400
400 Mbps Download/400 Mbps Upload
Fiber 600
600 Mbps Download/600 Mbps Upload
Fiber 1 GIG
1000 Mbps Download/1000 Mbps Upload
Fiber 2 GIG
* Wifi Equipment Not Included
Fiber 4 GIG
* Wifi Equipment Not Included
Fiber 6 GIG
* Wifi Equipment Not Included
Fiber 10 GIG
* Wifi Equipment Not Included
Additional Services
SmartNet
Service Assurance Plan
Brainiacs
Only $5 if added with SAP
BARK Jr.
Free Parental Controls App when signing up for MaxxFiber!
BARK Premium
WTFast Single
WTFast Family
Digital Home Phone Service
- None -
Yes
No
CPNI
?
Phone Number Options
Hosted Number
Ported Number
Number to Port
Do you want your phone number listed?
Yes
No
Additional Phone Lines Needed
Number of Beacons Needed
Installation Type
New Install
Reconnect Install
Change of Service
Number of Additional Outlets Needed
AutoPay Opt-In
?
Paperless Statement Opt-In
?
Estimated Monthly Rate
Installation Total
Total Due Today
Amount Pre-Paid to the Sales Rep
Payment Type
Cash
Check
Card
Other
Comments
Customer Signature
Customer agrees everything on the order is accurate.
Subscriber's Full Name
First
Last
Residential Sales Representative
Sign above
Residential Sales Representative
First
Last
Residential Sales Consultant email
Sales number
Leave this field blank
