*Email:      *=REQUIRED FIELD

                    *Name: 

              *Company:      

            *Telephone:      

                  Address:      

                        City: State:          CT         MA         NY       Zip: 

Additional Information (Optional)

How many locations do you have?:

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

How are theses locations connected?: Choose one Dial ip 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