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DSL Qualifier New! Dial-Up Access   Wireless Broadband Coverage

Name: Email Address: Street Address: City: State: Zip Code: Phone #: (If Preferred) Which Services Are you Interested in? DSL Internet (As Low As $29.95/month) Wireless Internet (As Low As $32.95/month) Dial-Up Internet (As Low As $9.95/month) Accelerated Dial-Up Internet (As Low As $14.90/month) VOIP Telephone (As Low As $19.95/month) Dish Network Television Would you be interested in receiving a discount for making automatic payments? Yes (up to $10/month discount) No

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