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Fill out the following form and click the "Submit Application" button at the bottom of the page to apply for Alphacomm.net's DSL service. If you are unsure of the answer to any of the questions, you may leave them blank and Alphacomm will contact you for clarification.

* Indicates required information.
Account Billing Information
Name *
Mailing Address*
City*
State*
Zip Code*
Daytime Telephone Number: *
Second Line Telephone Number:
Evening or Additional Contact Number:
Will you be disconnecting your second line?

DSL Subscriber Service
Exchange: *
DSL is only available to customers in the exchanges listed in the drop-down box to the right.
Phone number the DSL should be installed on: *
Is this phone number in your name?
Location Address: *
This is the address where the DSL will be physically located.
Do you currently have Internet service?

DSL Type
Recurring Billing Package:
For more details on these packages, view our High Speed Internet page.
Non-Recurring Sales:
Quantity   Purchase Plan
DSL Modem 660 - Single Computer
USB Wireless Adapter $51.53 (plus tax)
4-port Wireless Network Router
On-Site Installation Fee
Self Installation Kit - Shipping/Handling

Computer System
Operating System:*
Alphacomm.net does not support operating systems other than those listed.
Do you have a network (ethernet) card installed or a USB port?*
Do you have a home network (multiple computers connected together)?*
Is more than one computer going to be used?*

Phone Jacks
How many phone jacks are in your home or residence? (Include any unused jacks.)*
Number of devices in use: (Include phones, satellite receivers, faxes, garage extention phones, etc.)*
How many of your phones are mounted on the wall?*
A special filter is required for all wall mounted phones
Do you have an alarm system?*
If so, you will need to contact the alarm manufactuer to obtain a DSL filter

E-mail Service
Primary Email Address:*
All email addresses must be in the form of YourName@alphacomm.net
Password*
2nd Email Account
2nd Email Password
Additional Email Addresses ($1 each monthly)