DSL account setup form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastAddress *Address Line 1Address Line 2CityState / Province / RegionPostal Code--- Select country ---AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryEmail *Do you have a active phone line? *YesNoNew Activation *New Activation $70.00Please Note all prices are Subject to HSTInternet Plans *DSL 6 (up to 6 Mbps Download/up to 0.8 Mbps Upload) $35.95DSL 7 (up to 7 Mbps Download/Upload speeds up to 1 Mbps) $39.95DSL 15 ( Download speeds up to 15 Mbps/Upload speeds up to 1 Mbps) $44.95DSL 25 ( Download speeds up to 25 Mbps/ Upload speeds up to 1 Mbps) $49.95DSL 50 ( Download speeds up to 50 Mbps/ Upload speeds up to 1 Mbps) $59.95Please Note all prices are Subject to HST with pick Activation Modem Options *$100 Purchase SmartRG SR501 (not wireless)– Shipping included$130 Purchase ovislink (wireless)– Shipping includedRent $50.00 Deposit and Monthly payments of $5/month (not wireless)Rent $80.00 Deposit and Monthly payments of $10/month (wireless)Use your own ModemPlease Note all prices are Subject to HSTTerms of Service I authorize Jewl Communications to perform the necessary configurations on the subscriber line and network. Jewl Communications is NOT responsible for house. Modem Swap charge of $25 + HST applies if modem is changed or replaced I acknowledge that the Initial payment, which includes set-up fee plus first months' service fees, is required before the set-up may proceed. I understand that this summary of the service agreement between myself and Jewl Communications is only intended to be a convenience and does not supersede in any way the provisions of the Service Agreement to which I agree to be bound. The most current service agreement will be found at https://www.jewlcommunications.ca/terms-and-conditions/ There are no refunds on activation fees and or first month of service if the service is cancelled after the activation date. If a ticket is opened with the third party supplier, and the problem is determined to not be theirs, there is a DMC (Diagnostic and Maintenance Charge) of $95.00. Once a ticket is opened they cannot be closed. Do you Agree with the Terms Of Service *YesNoPlease pick date and time for activation? *DateTimePlease pick 2 weeks from todays date.Signature Clear Signature Submit