Phone Line Info

Please fill out this form as completely as possible. If you have ordered either a Flex or T1/PRI circuit, this information is very important. Thank you.

Business Name *
Address *
City *
State *
Contact *
Do you have a Fax Line? *YesNo
Fax phone number
Do you use a DSL line for your Internet? *YesNo
DSL phone #(if known).
Do you have an Alarm System? *NoYesUnknown
Alarm line phone #(if known).
Do you use a modem? *YesNoUnknown
Modem phone #(if Known).
Do you have a Credit Card machine *YesNo
Credit Card phone #(if known).
Please list your phone lines on your phones *
How do we contact you? *TelephoneEmailSite Visit-Call for Appt.
Any other info you think might help us.

Type the following: For security purposes, please type the letters in the image.