Application for DSL Services

DSL Application
Customer Name
Do you currently have Internet service with Copper Valley Internet?
What is the physical address of location where you want DSL service?
What telephone number do you want DSL service on?
E-mail address?
Your password?
DSL service connection speed?
Request Activation Date
Request Activation Time
Comments:

BUSINESS ACCTS ONLY:
Do you need an IP address?
If answered yes do you have: Router Web Server Email Server