Qwest DSL in Portland, Oregon and all western US states

* required information

CUSTOMER INFO

* Your Name:

(as it appears on phone bill)

Business Name:

(if applying for business DSL)

E-Mail Address:

Who Referred You?:
(enter their email address)

* DSL Service Address:

Address 1
Address 2
City
State
Zipcode:

(Is your shipping address different than your mailing address? Yes.

TECHNICAL INFO
* DSL Service Phone Number:	Stand Alone/Data Only
* Daytime Contact Phone Number:
* Computer Operating System:
* Billing Term Option:
* Yearly Service Contract Terms:	By submitting this form Customer agrees to the terms and condition in this Yearly Service Contract YEARLY SERVICE CONTRACT ONE (1) YEAR SERVICE CONTRACT: TERM: One (1) year from date of service activation. CANCELLATION: In the event of a cancellation of this Agreement prior to the end of the agreed contract term, opus:interactive will enforce a $150 cancellation fee, payable by credit card, at the time of the cancellation. A 30 day written notification is required for cancellation of all contracted services prior to the end of the term agreement. SERVICE UPGRADE: Customers may upgrade to other services offered by opus:interactive without penalty. TERMS of SERVICE: All terms of service apply, for more information please visit http://www.opusinteractive.com/tos.
* Desired Plan: click here for pricing details	NOTE: If your phone line qualifies for DSL, but not for the plan you selected, we will notify you by email or phone.
* Desired Hardware: click here for features	* Rented Modems provided by Qwest
Email Virus Scanning: click here for details
Do you need Static IP's?	Yes.
	Static IP's?:
Do you want content filtering? (residential customers only) What is content filtering?	Yes - $4.00/month No
* Desired Primary Email:	@
Alternate Primary Email:	@
Desired Secondary Email:	@
Alternate Secondary Email:	@
I want to:	Please select one: a. order my DSL right now. b. receive more information. (no obligation)
Current Internet Connection:	Please select one: New DSL (currently don't have DSL) ISP Switch (If ISP Switch, please select your current provider.)

OPTIONAL INFO
Comments:
Special Code: (optional)	(i.e. Discount, Partner, or Referral Code.)

By filling out and submitting this form, you are placing a firm order and agreeing to all charges associated with this service.