Please provide the following contact information:

Name
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Home Phone
E-mail

Tell us about your current Internet Access:

I don't have internet access Dialup 33.6K Dialup 56 K DSL Cable Modem

Tell us about your computer that needs Internet Access:

Single PC Workstation
Multiple PC Workstations
Single MAC Workstation
Multiple MAC Workstations
Single Laptop
Multiple Laptops
Network of Computers (laptop, pc workstation,..)

Do you have wireless network card :

No, I don't have one. Yes, I have a wireless card Yes, I have a wireless access point Not sure

In order to use our service you must either purchase or lease a wireless access card:

Willing to purchase it from us ($55) Willing to lease it from us ($5) Willing to buy else where

How much are you willing to pay for Internet Services monthly ?

$15 $20 $25 $35

What is your timeframe in accuiring Internet Service:

ASAP                  1 month               3 months              In the next 6 months