Only students without Internet Service are eligible Please enable JavaScript in your browser to complete this form.Date Parents or Eligible Persons Name *FirstLastStudents Name (If Applicable) *FirstLastName of School, Precinct, Fire Department or Pueblo (If From Pueblo Must Live on Pueblo Lands) *Select Type *K - 8th Grade 9th - 12th College Student Educator First Responder Tribal MemberEmail *Alt Contact *Phone *Alternative Phone # *Do you own or rent? *Own RentIf renting, you must obtain a letter of permission for us to be on the property to do an estimate or install your service.Mailing Address *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhysical Address *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeInternet - Residential* *Copper Plus- 25 Mbps- $29.95/ mo Turquoise- 50 Mbps - $49.90/moSilver-100 Mbps - $59.90/moGold- 150 Mbps - $109.90/moDiamond- 250 Mbps - $152.90/mo*All prices subject to change & do not include installation, taxes or applicable fees. Comment or Message1. Are there any animals on the property that we need'to be aware of? *2. Is there any equipment outside that can't be reached without encroaching on the neighbor's property? *3. Is there any landscaping that must be removed prior to construction? *4. Are there any unsafe or unsanitary areas on or near the location? *5. Are there any locked gates or fences that we must have access to? *CheckboxesAll prices subject to change & do not include installation, taxes or applicable fees. Kit Carson Internet bill is not included with electric bill. By submitting this application, customer is allowing KCI to enter property for estimate.MessageSubmit Application