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Inquiry Form

We’re always looking for new distribution partners (NSPs and ISPs). If you’re looking for ways to expand your business, please fill out the form below.


First Name:

Last Name:

Title:

Company Name:

Street Address 1:

Street Address 2:

City:

County:

State:

Zip:

Phone:

()   -  Ext. 

Fax:

()   -

Email:

Website:

Business Type:

 

Do you currently offer Internet services?

Yes no

If Yes, how long?

Do you currently offer Data services?

Yes no

If Yes, how long?

Length of time in business?


Services Provided:

Web Hosting
Web Design
VPN Dial-Up
ISDN T-1
Frame Relay Network Design
Voice Services Network Integration
DNS IP Services

Other Services Provided:

Services Desired:

DSL Dial-Up
IP Services Hosting Services
DNS Voice Services

Other Services Desired:

Services Desired?

Facilities-based Non-facilities based
Both Not Sure

HQ Market

 

HQ Market Other:

 

Additional Markets

Planned Markets

Number of Customers:

Customer Base Breakdown:

Residential %:
Small/Medium Business %:
Large/Enterprise %:

Projected Number of Lines per Year:

 

Comments:

  



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