*Email:     * = REQUIRED FIELD

                    *Name:

              *Company:     

            *Telephone:     

                  Address:     

                        City: State: CTMANYRIZip: 

How many locations do you have?:

Do you have any out of state locations?: no yes

How are theses locations connected?: Choose one Dial Up Tie lines Dedicated sevices Other

Do you use that connection for: Choose one Voice Video Fax Other

Are you satisfied with the transmission speed?: no yes

What is your rate per minute for intra and interstate calling?:

Is that switched or dedicated service?: Choose one Switched Dedicated