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Qualify Me for DSL!

In order to get this great new service at your home or business, you must first qualify for DSL service.  Please complete the following form to find out if you qualify.  The qualification process can take anywhere from 1 to 5 business days depending on your location. 

* You MUST have EXISTING telephone service with Southwestern Bell in order to get a DSL line!

Full Name:
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:
   
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.
Email Address:
Service Desired:
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?
  If other:
Comments or Questions: