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Qualify for High-Speed Service with ETI

* = Required Information
* Your Name:
* Your E-Mail Address:
* Company:
* Contact Phone: - -
** Site Phone: - -
** (Complete site phone number is needed to calculate circuit charges)
Fax: - -
* Physical Address:
* City:
* State:
* Zip Code:
Do you have multiple sites requiring connectivity? Yes No
If yes, please list each complete physical address and telephone number for each:
  Street Address City State Zip Code Phone Number
Site 2: - -
Site 3: - -
Site 4: - -
Site 5: - -
* How many Internet users will each site be supporting? 1-25 26-50 50-100 100+
* Do you plan to resell Internet service? Yes No
  If Yes, what do you plan to resell?
Dial up access PPP access Web hosting services
Leased Lines Co-located services
What line type(s) are you interested in? ISDN Frame Relay Point to Point Unknown
What are your bandwidth requirements?
Which term are you considering?

Other equipment/ services you will need are:
CSU/DSU Router
Terminal Server Modems
UPS OS Software
Configuration/Setup LAN Integration
Other (please specify)
* What is the time frame of installation for this Internet connectivity? 15-30 days 30-45 days 45-60 days 90+ days
* Proposed Budget ($US):
Is your organization currently with an access provider ? Yes, Current Provider
No
Do you have any other specific needs? (please describe) Yes No

(Limited to 300 characters and spaces)
How did you hear about ETI? (please provided name, location or description)
Print Ad Person Company Trade Show Web Site Other


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