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CUSTOMER ORDER
FORM
Customer Order
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Name
*
First
Last
Email
*
Phone Number
*
Package
*
4MBPS
6 MBPS
8 MBPS
10 MBPS
Address
*
City
*
State / Province / Region
*
Postal Code
*
Special Instructions
*
Confirmation
*
I acknowledge that I have read and agree to abide by the the Terms and Conditions
I acknowledge that upon submitting this form, my orders are final and can no longer be canceled
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