River Canyon Wireless - Sign Up
All fields must be completed before we will process the service application. First month is due at the time of install. Payments may not be accepted onsite. Alternatively, you may download a printable PDF application and mail or carry it in. Payment for install and the 1st month of service is required when install is completed. Install Technician may accept Cash, Check or Credit/Debit card. We reserve the right to use this information to carry out a credit check for service.
All fields marked with a * are required.
First Name:*
Last Name:*
Spouse Name:
Subscriber Date of Birth:*
Drivers License/ID #:*
ID State:*
-- Choose --
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington D.C.
Physical Street:*
Physical City:*
Moab
Blanding
Monticello
Castle Valley
Bluff
Bridgerjack
Green River
Price
Helper
Wellington
Spring Glen
Huntington
Castle Dale
Orangeville
Ferron
Clawson
Elmo
La Sal
Physical State:*
Utah
Physical Zip Code:*
Mailing Address:
Mailing Address same as Physical Address.
Mailing Street:
Mailing City:
Mailing State:
-- Choose --
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington D.C.
Mailing Zip Code:
Home Phone:*
Cell Phone:
Work Phone:
Email Address:
Paperless Billing:
I would like to receive my billing statements by email.
The cost of a wireless Router is not included in the install fee or the monthly rate. Routers are customer owned and purchased. If you would like to use the Internet on multiple devices, or you would like to have wireless inside your home, you will need your own router. If you do not already have a router, our technician can sell you one when he is installing your connection. The router our technician sells is $49.99 + Tax.
An install fee of $54.99 plus the first months service rate must be paid at the time of the installation. Please be prepared to pay at the time of your install. Installers can accept cash, check, credit or debit card on site.
Internet Service Plans (Pick One):*
-- Choose --
Basic Web Browsing - Monthly Fee $29.99 -- Up to 2 Mbps Download, 1 Mbps Upload*
Basic Video Streaming & Gaming - Monthly Fee $39.99 -- Up to 6 Mbps Download, 2 Mbps Upload*
Advanced Video Streaming & Gaming - Monthly Fee $49.99 -- Up to 8 Mbps Download, 3 Mbps Upload*
Basic Multi-User - Monthly Fee $59.99 -- Up to 12 Mbps Download, 4 Mbps Upload*
Advanced Multi-User - Monthly Fee $69.99 -- Up to 15 Mbps Download, 4 Mbps Upload*
-- Choose --
Basic Web Browsing - Monthly Fee $29.99 - $5.00/mo. B.O.B. Maintenance Fee -- Up to 2 Mbps Download, 1 Mbps Upload*
Basic Video Streaming & Gaming - Monthly Fee $39.99 - $5.00/mo. B.O.B. Maintenance Fee -- Up to 6 Mbps Download, 2 Mbps Upload*
Advanced Video Streaming & Gaming - Monthly Fee $49.99 - $5.00/mo. B.O.B. Maintenance Fee -- Up to 8 Mbps Download, 3 Mbps Upload*
Basic Multi-User - Monthly Fee $59.99 - $5.00/mo. B.O.B. Maintenance Fee -- Up to 12 Mbps Download, 4 Mbps Upload*
Advanced Multi-User - Monthly Fee $69.99 - $5.00/mo. B.O.B. Maintenance Fee -- Up to 15 Mbps Download, 4 Mbps Upload*
Bluff customers must pay a monthly B.O.B fee (Business Owner of Bluff). Residential customers pay $5 a month. The business fee is $10 a month. This is for construction and maintenance of the Equipment in Bluff
Both Subscriber and Landlord/Property Owner lines must be filled out in order to process this application. We must have both the Subscriber and the Property Owners names, even if they are the same person. By typing your name in the Digital Signature field you are legally digitally signing this application.
Online Account Access:
I would like to sign up for Online Account Access (Subject to Website Terms & Conditions .)
Preferred Username:
Preferred Password:
Terms of Service:*
I have read and agree to the Wireless Internet Service Agreement .
Subscriber Full Name (Digital Signature):*
Is this building a rental:*
Yes, Building is a rental.
Permitting and Landlord Approval: It is the Subscribers responsibility to obtain any and all required permits, homeowner association's approvals, mortgage grantors permission, or to grant or gain landlord approval for the placement of antenna on the Subscriber's building. Landlord/Owner consents to the installation, maintenance, and removal of the equipment described herein and required by the subscriber to receive River Canyon Wireless services.
Landlord Approval:*
I have received Landlord or Property Owner's approval for installation of antenna on my building.
Landlord/Property Owner Name:*
CAPTCHA Verification:*