Internet Form

This order form can be used to order up to 4 DSL services and one cable service for both residential and business installs. If at any time you require assistance, please feel free to call us at +1.604.629.8338 and press 1 for sales.

After you submit the order form, you will receive a document ID. Please make a note of it. We can reopen your order using that number.

Dry ADSL is ADSL installed without a physical phone line with dialtone.

The following scenarios are possible:

• If you have a physical phone line (not part of a hunt group) that you would like to install DSL on, Dry ADSL should be unchecked and the phone carrier should be entered
  • If the carrier is Telus, the phone number should be entered.
  • If an alternate carrier is used, we require the loop identifier which they can provide you.
• If you have a phone line by an alternate VoIP carrier (such as Shaw) proceed as if you have no physical phone line.
• If you have no physical phone line, Dry ADSL should be checked, and no Carrier or Phone Number is required.

Company:

Name:

Phone:

Fax:

Primary Contact: (Signing / Billing)

First Name:

Last Name:

Title/Position of Authority:

E-Mail:

Phone:

Extension:

Secondary Contact: (Site / Technical)

First Name:

Last Name:

Title/Position of Authority:

E-Mail:

Phone:

Extension:

Physical Address:

Apt/Suite:

House #:

Street Name:

City:

Province:
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

Postal/Zip Code:

Billing Address:

Same as Physical

Apt/Suite:

House #:

Street Name:

City:

Province:
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

Postal/Zip Code: