Residential Cable & Internet Application

Fill out the form below to apply for telecommunications services with Independence Light & Power. Please refer to www.ilpt.com for complete service descriptions and our terms of service. Contact us at (319) 332-0100 for additional information or if you have any questions. Thank you!

 


Your Information

 


Service Address

 


Billing Address

 


Cable Services

$29.95 install fee applies if you only subscribe to one service. Install fee is waived if you subscribe to two or more services.

 


Premium Movie Channels - Ala Carte

 


Internet Services

*$29.95 install fee applies if you only subscribe to one service. Install fee is waived if you subscribe to two or more services *Rates increase by $10.00 if you do not subscribe to cable.

**If you would like our wireless modem, please provide a Network Name and Password.

 


If not a current utility customer, please complete

**Copy of Photo ID required if not a current customer.**

Upload picture via phone or scanned image.
Files must be less than 6 MB.
Allowed file types: gif jpg jpeg png pdf.
Upload picture via phone or scanned image.
Files must be less than 6 MB.
Allowed file types: gif jpg jpeg png pdf.

 


Closest Living Relative

(First and Last)

 


Previous Utility Provider

 


Acknowledgement Of Terms

I have read and agree to all terms of service (available on www.ilpt.com or at Independence Light & Power, Telecommunications ) that I have applied for on this application.