1. Location > 2. Usage (Optional) > 3. Confirm > 4. Finished

1. Location (step 1 of 4)

What type of solution that you are interested in?

To complete your request, we need to know exactly where you want to receive service, as some locations have limited or no service available from Everus Communications. Please enter the physical address where you want to receive service below:

Company Name

(Required)

Primary Contact
First Name

(Required)

Primary Contact
Last Name

(Required)

Fire/House Number

(Required)

Street/Road name

(Required)

Apartment Number

Rural Route

City or Town

(Required)

Postal Code

(Required)

Are you the

Owner, Renter, or Other? (Required)

If "Other" please specify

Home Phone Number

( ) - (Required)

Work Phone Number

( ) - Ext

Cell Phone Number

( ) -

Email Address

Special Directions:
(e.g., Guard Dogs, Gates, Closest Intersection)

Where did you hear about us?

Promotion Code

Click for Rush Survey

There is a $99 charge for this service.
What is a rush survey?

1. Location > 2. Usage (Optional) > 3. Confirm > 4. Finished

2. Usage (Optional)
(step 2 of 4)

The following questions are OPTIONAL. The following questions are for market research use only. By answering them we can better understand your internet usage rate and determine the appropriate internet package and speed for your family's requirements. What do you want to do with the Internet? Number of computers? Check all that apply or may apply in the next six (6) months.
	Connect to Office (VPN)
	Share photographs over Internet
	Attend audio/video conferences
	Watch Youtube videos
	Internet phones (VoIP)
	File-sharing (P2P) Via Limewire, Bearshare, Bittorrent, etc.
	Download Music Via iTunes, MSN, etc.

1. Location > 2. Usage (Optional) > 3. Confirm > 4. Finished

3. Confirm (step 3 of 4)

Please review your information and ensure it is correct before submitting.

Location

Type of Solution:
Company Name:
Primary Contact
First Name:
Primary Contact
Last Name:
Fire Number:
Apartment #:
Road Name:
Rural Route:
Town:
Postal Code:
You are the:
Email:
Phone:
- Home:
- Work:
- Cell:
Special Directions:

Where did you hear about us?
Promotion Code:
Rush Survey:

Usage

# of Computers:
Expected Usage of Hi-Speed Internet within the next six (6) months:
- Connect to Office (VPN):
- Share photographs over the internet:
- Attend audio/video conferences:
- Watch YouTube videos:
- Internet Phones (Voip):
- File Sharing:
- Download Music:

1. Location > 2. Usage (Optional) > 3. Confirm > 4. Finished

1. Location (step 1 of 4)

2. Usage (Optional) (step 2 of 4)

3. Confirm (step 3 of 4)

4. Finished (step 4 of 4)

2. Usage (Optional)
(step 2 of 4)