Service Application Service Application Service Application Generic membership and service application form. Please note that a WCTA Account Representative will contact the phone number you've provided below to further complete our service application process. At that time, additional information like a social security number, credit card number, and other household information may be necessary. The call will be made during our business hours of 8:00am - 4:30pm, Monday - Friday. Name* First Last Service Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Please check if the Billing Address is the same as the Service Address above Billing Address is the same Contact Phone Number*Email Address Service Selection*Choose the services you're interested in to see your plan options Broadband Internet Digital Television Local Telephone Package DealsSelect one of these special package deals, or scroll down for a la carte options. All broadband internet plans include Premium WiFi. Speeds given are the same for both upload and download.Local Phone and Broadband InternetNoneLocal Phone and 100Mbps Internet +$64.95Local Phone, Broadband Internet, and Digital Television PackagesNoneLocal Phone, 100Mbps Internet, & Expanded Basic (2 TVs) +$147.50Local Phone, 100Mbps Internet, & Expanded Basic (4 TVs) +$154.95Broadband InternetAll broadband internet plans include Premium WiFi. Speeds given are the same for both upload and download.Internet-only plansNone25Mbps +$40.00200Mbps +$75500Mbps +$1501000Mbps (aka 1 Gigabit) +$250Digital TelevisionTelevision-only plansNoneBroadcast Basic (1 TV) +$27.95Expanded Basic (2 TVs) +$84.95Broadcast Basic includes local channels for 1 TV and the ability to pause and restart live TV (subject to availability); Expanded Basic includes Broadcast Basic plus cable networks for 2 TVs and access to content streaming through Watch TV Everywhere.How many ADDITIONAL digital TV boxes will you need?Every digital television plan comes with digital boxes for a specified number of TVs. Please indicate how many TVs you will have connected to the service BEYOND the provided number for the plan you've selected above. Price: $5.95 Quantity: Premium Movie Channels HBO Plex Cinemax Plex Showtime Unlimited Starz & Encore Plex Pick Any 2 Premiums Pick Any 3 Premiums All Premiums No charge to add if done at same time as initial TV service installation, otherwise a service fee of $12 will applyAre you interested in adding HD Channels for $3.95 per TV?YesNoHow many TVs should have HD? Price: $3.95 Quantity: Are you interested in adding Cloud DVR service for $6.95?YesNoCloud DVR allows you to schedule recordings from any TV and play them back on any other TV in the house.Local PhoneDo you currently have local phone service? (e.g. a landline phone)* Yes No Would you like to keep your same home phone number?*YesNoPhone-onlyNoneResidential Phone +$23Prices may vary depending on your location; an Account Representative will clarify pricing during our initial setup call.Section BreakA la carte discount (2 Services) Price: -$2.00 A la carte discount (2 Services) Price: -$2.00 A la carte discount applied (2 Services) Price: -$2.00 A la carte discount (3 Services) Price: -$4.00 Service Estimate (before taxes & fees) $0.00 Prices may vary depending on your location; an Account Representative will clarify pricing during our initial setup call.CommentsThis field is for validation purposes and should be left unchanged.