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Name

Email Address

Subject

Department

Priority

Message

Attachments

Allowed File Extensions: .jpg, .gif, .jpeg, .png, .doc, .txt, .ott, .ott, .xls, .csv, .rtf, .pdf, .docx, .img

Street Address To Be Checked For Serviceability - Then Please Answer Other Questions

Unit Type (If Not A House)

Apartment, Unit or Suite No. (If Applicable)

City or Town (or Equivalent)

Township (Optional - If a Rural Address)

Province

Postal Code (without spaces)

Is there a Cable TV line running to this home (active or not)? (Not including from a satellite dish.)

Do not leave blank.

Is there currenty high speed internet over the cable TV line at this address?

Do not leave blank.

Please enter name of current Cable Internet provider for that address (if applicable & if known)

Do you currently have an active telephone number & landline at that home?

Do not leave blank.

Do you currently have internet over the phone line (DSL or FTTN or Fibe) at that address?

Do not leave blank.

If Yes - Please Enter Land Line Area Code & Phone Number (No Mobile phone numbers please.)

(This may help us better locate your address. We will not call you.)

Will The Internet Be For Home or Business Use?

Do not leave blank.