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2. First Name
3. Last Name
5. Service Address
7. City
8. State
9. Zip Code
11. Billing address same as service address?

    1. Yes

    1. No
13. Billing Address
15. City
17. State
18. Zip Code
20. Phone Number
21. Email Address
23. Which package(s) are you interested in?

    1. MiNet 300

    1. MiNet 600

    1. MiNet 1G
25. Are you in a contract with internet service provider?

    1. Yes

    1. No
27. If so, when does your contract expire?
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29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

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