SpeedyQuick Networks - High-Speed Internet Access for Boise, Meridian, Nampa, Caldwell, & Star

	Business Account
	Residential Account

Signing up with SpeedyQuick Internet services

If you would like to order SpeedyQuick Internet service, please fill out and submit the following form. We will verify that you are in our coverage area, then contact you to arrange installation.

Become an SpeedyQuick Internet Dedicated access member! We accept Visa, Mastercard or check;

Fields marked with ^* are required.

*REFERRAL*
How did you hear about us?^*
Comment	Please let us know your friend's username, particular magazine or web site where you saw our ad, etc., if applicable.
*CONTACT INFORMATION*
SpeedyQuick Username: (if you are a current SpeedyQuick customer)

*First Name^:**
*Last Name^:**

*Address^:**

*City^:**
*State^:**
*Zip^:**

Email Address:

Home Phone Number
Work Phone Number
Fax Number	( Phone Number format: xxx-xxx-xxxx )

Contact me by:

*SERVICE*
*Type of Service^:**
Contract:
Speed of Service:
Number of Computers:


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