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Ready to start STREAMING on your TV?

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

First Name

Last Name

Date of Birth

Month

Day

Year

Social Security #

Co-applicant First Name

Co-applicant Last Name

Co-applicant Date of Birth

Month

Day

Year

Co-applicant Social Security #

Service Address

Address Line 2

City

Billing Address

Address Line 2

City

State

Zip Code

Other Residents (over 18)

Daytime Phone

Cell Phone

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.

Do you have cable now?

Yes

How many TVs will be connected?

Will you need any cable outlets?

Cable Service Choice

Lifeline Basic (2-38) | $24.95

Standard Basic (2-95) | $89.95

Standard Plus (2-136) | $99.95 Box Required w/ Std Plus

Digital Box | $10.00

DTA Box (No Guide) | $2.00

DTA Box Quantity

Additional Receiver Boxes | $ 7.50

Additional Receiver Box Quantity

Dual DVR | $ 8.95

Dual DVR Quantity

Premium Movie Channels - Ala Carte

Movie Channel Selection

HBO (6 channels) | $ 16.95

Showtime (8 channels) | $13.95

Cinemax (7 channels) | $12.95

StarzEncore (13 channels) | $9.95

NFL Redzone (Season Price) | $49.95

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.

How many devices do you have?

Residential Rates

Lite (4Mb Dn/1Mb Up) Light activity and Social Media | $29.95

Standard (100Mb Dn/5Mb Up) Streaming & Multiple Devices | $49.95

Plus (250Mb Dn/25Mb Up) Gaming & Video Uploading | $79.95

Gigabit (1,000Mb Dn/1,000Mb Up) High user, home office | $99.95 (Fiber Customers Only)

Do you have a wireless router?

Yes

No, add wireless modem for $5/mo.**

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

Network Name

Network Password

If not a current utility customer, please complete

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

Applicant Photo ID

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

Applicant's Current Employer

Current Employer Street Address

Address Line 2

City

State

Zip Code

Current Employer Phone

Supervisor's Name (First and Last)

Co-applicant photo ID

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

Co-applicant's Current Employer

Co-applicant's Current Employer Address

Address Line 2

City

State

Zip Code

Closest Living Relative

Relative Name

(First and Last)

Relative Phone Number

Previous Utility Provider

Name of current or 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.

Consent

Agree

Leave this field blank

Electric
Cable
Internet
Phone
Streaming

Independence Light & Power Telecommunications
700 7th Ave NE
Independence, IA 50644
(319) 332-0100
Hours: Monday-Friday 7:00 am – 4:00 pm