Government Entity	Select One United States/Federal State County Local/Municipal
Agency
Type of Service: (required)	Select One Analog Point to Point Digital Point to Point Dedicated Internet Access Satellite Services Frame Relay ATM
Line Speed: (required)	Select One Radio/Voice 2.4 kbps 4.8 kbps 9.6 kbps 19.2 kbps 56 kbps 64 kbps Fractional T-1 128 kbps Fractional T-1 384 kbps Fractional T-1 896 kbps Fractional T-1 T-1 T-3 OC-3c OC-12c OC-48 Internet Access 56 kbps Internet Access T-1 Internet Access T-3 Internet Access OC-3c
Service Term: (required)	Select One Month to Month 12 Month Commitment 24 Month Commitment 36 Month Commitment 60 Month Commitment
Location One NPA (Area Code): (required)
Location One NNX (Exchange): (required)
Location One Address:
City:
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Zip Code:
Location Two NPA (Area Code): (required)
Location Two NNX (Exchange): (required)
Location Two Address:
City:
State:	Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code:
Full Name: (required)
E-mail Address: (required)
Company/Orgainization: (required)
Business Address:
City:
State:	Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code:
Telephone: (required)
Fax: (required)