eBill and Recurring Direct Debit Payment Enrollment Form

Form Date 111908

Dear Valued Wave Broadband Customer:

Thank you for your interest in Wave Broadband’s eBill and Recurring Direct Debit

programs.

Please carefully read, complete and sign the attached Enrollment Form. Please be sure

you have done the following:

1. Fill out the Enrollment Form completely.

2. Attach a voided check (a deposit slip is not sufficient) with the Enrollment Form.

3. Review the Terms and Conditions.

4. Sign and date the Enrollment Form.

5. Return the completed Enrollment Form and your voided check by mail or by fax to:

By mail: Wave Broadband, Attention: Billing

P.O. Box 34808, Seattle, WA 98124

By fax: 877-205-4295

Or, deliver the completed Enrollment Form and your voided check to your local

Wave Broadband office or retail center.

Please continue to pay your Wave Broadband billing statement as you have in the past

until your statement reflects your Recurring Direct Deposit enrollment was successfully

processed.

If you have questions or need additional information, please contact us at 866-928-3123.

Thank you.

WAVE BROADBAND

Form Date 111908

eBill and Recurring Direct Debit Payment Enrollment Form

eBill Enrollment

I, the customer identified below (“Customer” or “I” or “my”), authorize Wave Broadband to enroll me in Wave’s eBill program. I understand

my paper billing statement will be suppressed and I must access www.wavebroadband.com to view my monthly billing statement

information or to download a copy of my Wave Broadband bill. I have provided in the space below an email address that Wave can use to

notify me when my monthly billing statement is available for viewing on-line. I understand I can cancel my participation in Wave’s eBill

program at any time on notice to Wave.

Request Type (Check One): New Enrollment Cancel eBill

Email Address: _________________________________________________________

Recurring Direct Debit Authorization

Wave Broadband Account Information

Customer Contact Information

Customer Name: (As it appears on your Wave Broadband bill)

Contact Name:

Wave Broadband Account Number:

Phone:

Service Address:

Email Address:

Request Type (Check One):

New Enrollment Change Information

Cancel Recurring Direct Debit Authorization

Billing Address:

I authorize Wave Broadband to initiate scheduled recurring electronic funds transfers from my checking account identified below (“my

account”) for payments due from time to time on the Wave account shown above. I understand Wave will initiate transfers from my account

for the amount due. I understand I have the right to receive written notice of the scheduled date and amount of each transfer varying in

amount from the previous transfer.

I authorize Wave to initiate transfers only in the amounts shown on Wave’s monthly billing statements that are sent to me at least 10 days

before the scheduled payment due date shown on each such billing statement. I understand billing statements will be sent to my billing

address or emailed to my email address if I have elected eBill enrollment. The scheduled payment dates will be the payment due dates

shown on each such billing statement – except when such payment due date falls on a day that is not a business day at the financial

institution that maintains my account, in which event the scheduled payment date will be the next business day after the payment due date

shown on the billing statement.

ALL CUSTOMERS WILL RECEIVE MONTHLY BILLING STATEMENTS REGARDLESS OF THE OPTION SELECTED.

I understand that authorization of electronic funds transfers from my checking account as the method of making payments on my Wave

account identified above is entirely optional and is not required to obtain or maintain my account with Wave.

I understand that I may at any time by notice to Wave, request that electronic fund transfers from my checking account pursuant to this

Authorization be discontinued, and that Wave will not initiate further electronic transfers from my account pursuant to this Authorization

after Wave has received my notice and had a reasonable period of time on which to act upon it. This right is in addition to my rights to stop

payment by directly contacting my financial institution where I maintain my account.

By my signature below, I acknowledge I understand and authorize all of the above, I acknowledge and agree to the Terms and Conditions

on the reverse side of this form, and I acknowledge receiving a copy of this Authorization for my records.

REQUIRED INFORMATION: Please attach a copy of a voided check for the account listed below.

Financial Institution:

Bank Routing / ABA Number: (first nine digits – see bottom of check)

Branch:

Bank Account Number:

City / State / Zip Code:

Customer’s Authorized Signature: _________________________________________ Date: ___________

Please return the completed and signed Authorization form and your voided check by mail or fax to:

MAIL: Wave Broadband, Attention: Billing, P.O. Box 34808, Seattle, WA 98124

FAX: 877-205-4295