WINspeed DSL Order Form

Complete this form to order WINspeed DSL Internet service. Please leave a phone number and best time to call so that we may complete your order. Once you hit submit this order will be emailed to our customer serivce team.

Name:
Address:
City:
State:
Zip Code:
Phone:		Best Time to Call:
Secondary Phone:
email:
I would like to sign up for:
256K	$29.99/mo +$50 standard install
1MB	$39.99/mo + $50 standard install
SecureIT Services	$7.99/mo + $10 install
Lease Modem/Surge Protector	$5.00/mo
Purchase Modem/Surge Protector	$174.99 + $39.99

Preferred User Name:	15 character MAX, three character minimum--no “&” sign or symbols, must begin with a letter
Additional Emails:	You are allowed up to 5 emails, with the @westianet.com domain.

Additional Questions/Comments:

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WINspeed DSL Order Form