We are happy to have you! Thank you for the opportunity to provide your home with High-Speed Internet, HD Cable TV and/or Home Phone service. Fill in the form below to register to receive your Rewards Card. Welcome Back Reward Card Account Number Full Name First Last Address Address Address 2 City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code Email Address Phone Number Date I agree to the terms of service. Rewards Card Terms of Service You are accepting our $100 Gift Card Promotional Offer based on a 12-month RSA. You agree to the installation of one (1) core service (Video, Internet, Home Phone) and continuation of the service at that level or higher for at least twelve months. Services must be ordered and installed at the same time and on the same Work Order. Account must remain in good standing for at least sixty (60) days and must have a balance of $5.00 or less on the 60th day. If these requirements are met, the Reward Card will be mailed 90 days after installation. If a customer downgrades or disconnects the service, for any reason, after that 90 day period, an early termination fee equal to Gift Card value will be charged and the Reward Card offer will be terminated. Any prior due balance amounts must be paid in full to be eligible for Reward Card offers. Non-pay customers are ineligible for this entire offer. Limit one reward card every 365 days. Move transfers do not qualify. Wireless connections, networks and other factors may impact Internet speeds. Rates are subject to rate and fee increases and Broadcast Retransmission Fees, Internet Equipment Fees, Internet Consumption Fees, Franchise Fees, Activation Fees, and others will apply. Terms and conditions of MaxxSouth service (available at maxxsouth.com/legal) apply. Offer subject to change or may be canceled without notice. You are accepting our $200 Gift Card Promotional Offer based on a 12-month RSA. You agree to the installation of two (2) core services (Video, Internet, Home Phone) and continuation of the service at that level or higher for at least twelve months. Services must be ordered and installed at the same time and on the same Work Order. Account must remain in good standing for at least sixty (60) days and must have a balance of $5.00 or less on the 60th day. If these requirements are met, the Reward Card will be mailed 90 days after installation. If a customer downgrades or disconnects the services, for any reason, after that 90 day period, an early termination fee equal to Gift Card value will be charged and the Reward Card offer will be terminated. Any prior due balance amounts must be paid in full to be eligible for Reward Card offers. Non-pay customers are ineligible for this entire offer. Limit one reward card every 365 days. Move transfers do not qualify. Wireless connections, networks and other factors may impact Internet speeds. Rates are subject to rate and fee increases and Broadcast Retransmission Fees, Internet Equipment Fees, Internet Consumption Fees, Franchise Fees, Activation Fees, and others will apply. Terms and conditions of MaxxSouth service (available at maxxsouth.com/legal) apply. Offer subject to change or may be canceled without notice. You are accepting our $300 Gift Card Promotional Offer based on a 12-month RSA. You agree to the installation of three (3) core service (Video, Internet and Home Phone) and continuation of the services at that level or higher for at least twelve months. Services must be ordered and installed at the same time and on the same Work Order. Account must remain in good standing for at least sixty (60) days and must have a balance of $5.00 or less on the 60th day. If these requirements are met, the Reward Card will be mailed 90 days after installation. If a customer downgrades or disconnects any service, for any reason, after that 90 day period, an early termination fee equal to Gift Card value will be charged and the Reward Card offer will be terminated. Any prior due balance amounts must be paid in full to be eligible for Reward Card offers. Non-pay customers are ineligible for this entire offer. Limit one reward card every 365 days. Move transfers do not qualify. Wireless connections, networks and other factors may impact Internet speeds. Rates are subject to rate and fee increases and Broadcast Retransmission Fees, Internet Equipment Fees, Internet Consumption Fees, Franchise Fees, Activation Fees, and others will apply. Terms and conditions of MaxxSouth service (available at maxxsouth.com/legal) apply. Offer subject to change or may be canceled without notice. Leave this field blank
