STARNET WIRELESS - HIGH SPEED INTERNET SERVICE AVAILABILITY REQUEST

Please provide as much information as possible including the telephone number (if one exists) of the address you are checking for availability. Some areas are covered with DSL and the telephone number is important for determining service availability. Please check all information for accuracy as contact is made using the email address or contact phone number provided. Thank you.

***ALL INFORMATION PROVIDED IS USED ONLY FOR THE PURPOSE OF CHECKING AVAILABILITY OF SERVICES AND PROVIDING INFORMATION ABOUT STARNET WIRELESS SERVICES***

***YOUR REQUEST WILL BE DISCARDED IF YOU OMIT ANY NECESSARY INFORMATION OR DO NOT COMPLETE THIS FORM***
First Name *
Last Name *
Street Address (include apartment or unit number) *
City *
State *
Zip Code *
What is the local telephone number at this address? If one does not exist, please specify the normal area code and first three digits (Ex. 989-322). If you do not know, please specify "none". *
Contact Phone Number *
Contact Email Address *
Where did you hear about us? (please select a source) *
Were you referred by a current StarNet customer? (if so, please specify name as they may be eligable for credit)
Please add any additional questions or comments