Customer Facing New Service Signup

1
Are you a current customer?* This field is required.
YESNO
2
What type of service are you looking for?* This field is required.
Internet & Phone
Just Internet
Just Phone
3
What type of account are you looking for?* This field is required.
Residential
Commercial
4
What types of devices do you have?* This field is required.
Desktop Computer/Laptop
Smart Phone
Tablet / iPad
Roku/Apple TV/Amazon Fire Tv/ Other streaming box
Xbox/Playstation/ Other Video Game Console
Printer
Smart Home Devices (lightbulbs, Video Doorbell, Alexa, Vacuum, Ect)
Home Security (Security Cameras, Home Alarms, Smoke Detectors, Ect)
5
How do you plan to use the Internet?* This field is required.
Work From Home
Streaming TV or Movies
Social Networking (Facebook, TikTok, Twitter, Etc)
Basic Web Browsing (Blogs, Chat, News, Online Banking)
Online Gaming
6
Do you have a phone number you wish to keep?* This field is required.The phone number you wish to keep must be on and active in order to keep your number.
YESNO
7
Please list all phone numbers you wish to port* This field is required.


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Large
Normal
Small
Ok
Ok
8
Business Name* This field is required.
9
Name* This field is required.
First Name
Last Name
10
Address* This field is required.Please enter the physical address you want service. Note:This cannot be a PO Box.
Street Address
Street Address Line 2
City
Please Select
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
11
Lets see what type of buried services you have on your propertyIf we deem fiber service is available at your address, We will need to install a buried cable and equipment on your property. Missouri One Call trained locaters will detect and mark ONLY the following types of lines; Electric Wire between the electric company’s main line and your electric meter,Telephone Company owned lines to your service, Natural Gas Line to your house, any village maintained sewer and water lines. Do you have any other buried services? It is the responsibility of the homeowner/property owner to locate and expose any other facilities on the property along the proposed work route indicated by white flags/paint.
Private electric lines (to sheds, lights, exterior outlets, etc.)
Propane/fuel oil lines
Sewer/Septic lines
Water lines (Hot tub, animal water system, geothermal, etc.)
Drain Tile
Outdoor wood stove lines
Satellites or other telecommunication wires
Sprinkler Systems
Underground dog fence
Other buried items
No Buried Items
12
Phone Number* This field is required.Please enter a number where you can be reached.
Please enter a valid phone number.
13
Type Of Phone Number Provided* This field is required.
home
mobile
work
14
Email* This field is required.
example@example.com
Email Verified
The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification
••••
Didn't receive verification code? or
Receiving the email may take a few minutes, thank you for your patience!
15
I {name}, acknowledge that the items below exist at {address} and agree to locate and expose these items which exist within the property that would NOT be identified by Dig Rite. I further agree that Air Link is not responsible for damage to any facilities buried underground which are not marked and exposed.

{letsSee}

Signature
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