Sign up

Sign Up

Fill out this form to register your new Element Wireless Service. We cover a 5 mile radius around the Fisk, MO area, using this form does not guarantee service at your residence or place of business all service’s are pending a site survey. After you submit this form we will contact you and schedule a site survey to determine if we can provide you with a stable internet connection at the plan you requested.

Name*



Phone*



Your Email*



Address*




Select your plan


Preferred time to contact you


Contract


How did you hear about us?


If you were referred by your friend, family, or neighbor. Please put their six digit referral code in the box below.


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Terms of service

By checking this box you agree to our policies listed here


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