Order Now—Application for Residential Service
All information will be kept confidential

Personal Information (* = required)

*First Name

*Last Name

*Service Address

Billing Address (if different)

*Daytime Phone

*Evening Phone

Cell Phone

Email

*Preferred method of contact?

*Do you rent or own at service address?

Landlord's Name

Landlord's Telephone

Landlord's Address

How did you hear about us? Click all that apply.

Received catalog

Received postcard

Received door hanger

Saw advertisement

Word of mouth

Referral

Were you referred by:

SEABA: South End Arts and Business Association?

City Market/Onion River Co-op?

Landlord:

(Please provide name:)  

Other:

(Please provide name:)  

None of the above.

Choose from one of these triple or double play packages (or make your own package, see below )

Champlain Bundle | $125 (Triple Play)

Queen City Bundle | $165 (Triple Play)

Lighthouse Bundle | $80 (Double Play: Internet & Telephone)

Champ Bundle | $90 (Double Play: Television & Telephone)

Boathouse Bundle | $110 (Double Paly: Television & Internet)

I'll make up my own package below, thank you

Make your own package—Step 1: Choose your Internet Service

8M/8M - up to 8Mbps

Static IP address option ($8)

No internet service, thank you

Make your own package—Step 2: Choose your Telephone Service

Community Unlimited

USA Unlimited

No telephone service, thank you

Additional features such as Voice Mail, Call Forwarding, and Caller ID can be added when Burlington Telecom calls to confirm your order or arrange for an installation date.

Make your own package—Step 3: Choose your Cable Television Package

BTV Basic – approx. 30 channels

BTV Standard – approx. 90 channels

BTV Standard Plus – approx. 150 Channels

BTV Premium – approx. 250 Channels

No cable TV service, thank you

Premium Services & Networks:
Save when you order all the Premium Networks: $50!

HBO – 7 channels w/HBO on Demand ($15)

Showtime – 12 channels w/Showtime on Demand ($13)

Cinemax – 8 channels w/Max on Demand ($13)

Starz – 13 channels, including all Encore channels ($13)

Encore – 7 channels ($9)

High Definition Service ($12) (See an overview of our HD lineup broken down by tier)

Digital Video Recorder Service ($17)

Combo Hi-Def & Digital Video Recorder Service ($25)

Premium Foreign Language Channels:

SBTN Vietnamese ($10)

TV5 French ($10)

Additional Options:

Additional Standard Definition Set-top Boxes ($5.00) (The first set-top box is included.)

How many?

Inside Wire Maintenance (IWM)
$5/month (included in pre-made Triple and Double Play Packages)
Note: we guarantee our installs for 30 days, so the first month of the IWM Plan is free. After the first month you are responsible for the wires inside your home unless you choose our IWM plan.

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After submitting this application, a customer service representative will contact you to verify your application and schedule an appointment.