NOL QUICK QUALIFICATION FORM
Full Name:
REQUIRED
Company Name:
* Only complete this if the DSL line will belong to the company!
Address:
* This must be the actual address where DSL will be installed!
City, State, Zip:
Texas
REQUIRED
DSL Phone Number:
* This must be the actual phone number where DSL will be installed!
Contact Number:
* Number where you can be reached regarding this inquiry.
REQUIRED
Email Address:
Service Desired:
Dynamic Single IP Address
Advantage 8 IP
Advantage 16 IP
Advantage 32 IP
Advantage 64 IP
Advantage 128 IP
Advantage 256 IP
I will use DSL for:
Home
Business
My current service level is:
Modem
ISDN
Cable
T1 or Frame Relay
No Internet Access
How did you hear about our DSL product?
Our Web Site
Texas Technology Magazine
Southwestern Bell
56K.com
Radio
Friend
Yahoo!
Snap.com
Other
If other:
Comments or Questions: