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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

Daytime Phone *

Cell Phone *

Email *

Co-applicant First Name

Co-applicant Last Name

Co-applicant Date of Birth

Month

Day

Year

Co-applicant Phone

Other Residents (over 18)

Service Address

Service Address *

Address Line 2

City *

Billing Address

Address Line 2

City

State

Zip Code

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) | $39.95

Standard Basic (2-95) | $109.95

Standard Plus (2-136) | $119.95 Box Required w/ Std Plus

Digital Box | $10.00

Set Top Box (With Guide) | $5.00

STB (Set Top Box w/ Guide) | $5.00

STB 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) | $15.95

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.

How many devices do you have?

Residential Rates

Lite (4Mb Dn/1Mb Up) Light activity and Social Media | $39.95

Standard (100Mb Dn/5Mb Up) Streaming & Multiple Devices | $59.95

Plus (250Mb Dn/25Mb Up) Gaming & Video Uploading | $89.95

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 router 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

Emergency Contact

Name *

(First and Last)

Phone Number *

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