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Shasta.Com's DSL Service


DSL Service Order

Please input the following information, Shasta.Com will review it and contact you regarding your installation date.

Your Full Name


Business Name
Optional


Your Street Address
Please use address where service will be located


Suite or Apartment Number
Optional


City


Zip Code


Your Telephone Number
Please use telephone number at service address, if you are ordering ADSL, please use a telephone number that is not part of a centrex group or PBX system.


Your E-Mail Address


Referred By (If applicable)


It is necessary to have one of the connections below available for the DSL modem.

Does your computer have USB ports available?
Yes No Don't Know

Does your computer have an Ethernet Card installed?
Yes No Don't Know


Type of DSL Service you are ordering


Is IDSL service acceptable to you if the product you are ordering is not available in your area?
Yes No

Payment Method
Bill my existing Shasta.com account
Credit Card  Exp: