US Net, L.L.C. The Freedom to Succeed
 

DSL ORDER FORM

Sign-up today and get your first 3 months at half-price!

Note: If you have an existing prepaid dialup Internet access account, the amount of your current credit balance will be applied to your new DSL account.
 
Fields with an * (ASTERISK) are required.
   
 Company Name
       
 First Name * Last Name *
   
 Current E-mail *
   
 Address 1 *
   
 Address 2
       
 City *
       
State *
       
 Zip Code * Plus 4
   
 Country *
   
 Main Phone xxx-xxx-xxxx *
   
 
 
 Choose A DSL Plan *
 
 
 
 Choose Payment Term *
   
 Choose A Credit Card *
   
 Credit Card # *
   
 Name on Card (Name exactly as it appears on card.) *
   
 Expiration Date mm/dd/yyyy *