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Street Address To Be Checked For Serviceability - Then Please Answer Other Questions
Unit Type (If Not A House)
Ingen
Unit
Suite
Lot
Apartment
Floor
Basement
Townhouse
Building
Penthouse
Room
Trailer
Rear
Lower
Upper
Étage
Sous-sol
Maison de ville
Bâtiment
Chambre
Arrière
Apartment, Unit or Suite No. (If Applicable)
City or Town (or Equivalent)
Township (Optional - If a Rural Address)
Province
Ontario
Quebec
Alberta
British Columbia
Newfound & Labrador
Nova Scotia
New Brunswick
PEI
Saskatchewan
Manitoba
Yukon
NWT
NU
Other
Postal Code (without spaces)
Is there a Cable TV line running to this home (active or not)? (Not including from a satellite dish.)
No - Non
Yes - Oui (Rogers)
Yes - Oui (Cogeco)
Yes - Oui (Videotron)
Yes - Oui (Shaw)
Yes - Oui (Eastlink)
Yes - Oui (Compton)
Yes - Oui (Source)
Yes - Oui (Access)
Yes - Oui (Other)
Unknown - Inconnue
Do not leave blank.
Is there currently high speed internet over the cable TV line at this address?
No - Non
Yes - Oui
Unknown - Inconnue
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?
No - Non
Yes - Oui
Unknown - Inconnue
Do not leave blank.
Do you currently have internet over the phone line (DSL or FTTN or Fibe) at that address?
No - Non
Yes - Oui
Unknown - Inconnue
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?
Home - Maison
Business - Affaires
Both - Les deux
Do not leave blank.
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