2. Does your address currently have utility service with the CBPU?*

   1. Yes
   2. No
3. If your address does not currently have Electric or Water service with the CBPU, we may not provide Fiber Service in your area. For more information, please contact the CBPU at 517-279-9531.
5. Are you a business or a residence?*

   1. Residence
   2. Business
7. Service Address Line 1*
9. Service Address Line 2
11. City*
12. State*
14. Zip Code*
16. Is your mailing address different from your service address?*

    1. Yes

    1. No
18. Mailing Address Line 1
20. Mailing Address Line 2
22. Mailing City
23. Mailing State
25. Mailing Zip Code
27. Primary Account Holder First Name*
28. Primary Account Holder Last Name*
30. Primary Account Holder Phone Number*
31. Primary Account Holder, Secondary Contact Information

    Please provide us with a second way to reach you. This can be an email or a phone number. If it is a phone number, please input the phone number in this format: (517) 279-9531

33. Plume Managed WIFI - $4.99/mo

    1. Yes
    2. No
34. Additional Pods - $2.99/mo Each
    -- Select One --0123456
36. How did you hear about CBPU Gig-Fiber?*

    Please check all that apply:

    1. Door Hanger
    2. Informational Brochure
    3. Was Given A Flyer
    4. From A Piece of Mail
    5. Social Media
    6. City/CBPU Website
    7. News Story
    8. Word of Mouth
40. Activation and installation fees may apply.
42. If this form does not cover your request, please feel free to contact CBPU at 517-279-9531, Monday-Friday, 8:30 a.m. to 5:00 p.m.
44. We may need to contact you at the phone number that you have provided regarding your request.
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

* indicates a required field