Check Service Availability CCEC Member Interest Form Are you a CCEC member? Yes No Is Beacon Broadband service available? - None -Yes No Member Name First Last Email Phone Number Service Address Address Address 2 City/Town ZIP/Postal Code Current Service Provider Spectrum Ziply Starlink Other… Enter other… What services is the member interested in? Internet Voice Video Residence Type Rent Own Homeowner Approval Status: Has the member obtained approval from their homeowner? Yes No Interest Rating Questions Not Interested Neutral Very Interested How interested in Beacon Broadband is the member? Not Interested Neutral Very Interested Notes/ Details/ Concerns MSR - Select -DarianLaciLouiseMirandaPashaRachealOther Who is filling out this form? Submit Leave this field blank
