Quantum Internet Services, Inc.

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Business Telephone Service Inquiry

Please provide us with your information below and we will contact you.

NOTE: Fields marked with a red asterisk (*) are required.

Company Name:

Contact Name:

Contact Phone:

Best time to reach you: Day Evening

Address:

City:

State:

Zip Code:

E-mail Address:

I am interested in the following services: (Check all that apply)

Long Distance
Local Calling

Dialup Internet
DSL Internet
Broadband Internet

Number of phone lines:

Use of Quantum's services, systems, servers, and facilities, constitutes the customer's agreement with Quantum's Rules and Regulations, and the Quantum Connect Contract, both of which are subject to change without notice.