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First Name
*
Last Name
*
Business Name (optional)
Physical Address
*
Physical Address - Line 2
City
*
State
*
- Select Province/State -
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
====================
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
*
Cell Phone Number
*
Home Phone Number
Work Phone Number
Email Address
*
Your Current Internet Service Provider (if applicable)
Choose your desired plan:
*
6 Mbps Down (3 Mbps up) $59.99
Gamer's Choice - 10 Mbps Down (5 Mbps up) $89.99
Business Select - 10 Mbps Down (5 Mbps up) $89.99
Ultimate 25 Mbps Down (5 Mbps up) $129.99 (*Where available. Not available in all areas.)
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