Roku Rental Form
Jade Communications, LLC
129 Santa Fe Avenue
Alamosa, CO 81101

Please complete and submit the application below to rent a Roku.
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    Please provide a phone number of another person
  • Equipped with lightening fast processors, Roku offers endless streaming possibilities for you and your family. We offer 3 powerful models for you to choose from.
  • Jade Communications will automatically charge this bank account number for the amount of your bill on the 5th day of every month.
  • I agree to a credit check which is required for service.
    I acknowledge that if I do not pass the required credit check, a deposit is required for service.
    I agree to pay Jade Communications the entirety of the installation fee prior to installation.
    I agree to pay a $95.00 equipment retrieval fee, if the equipment is not returned after 10 days of disconnect.
    I agree to pay all charges within 10 days of issuance and to pay all reasonable costs of any collection agency (up to 50% of the outstanding bill), attorney, court or other miscellaneous fees used to collect the past due amounts.
  • By checking this box, I acknowledge that the information provided in this application is factual and true.
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