Home
Phone
Broadband
Fiber
Colocation
Support/Contact
More
Information Request
Please submit this form and a sales representative will contact you shortly.
Your Contact Information
Surname:
Mr.
Ms.
Mrs.
Dr.
First Name*
Last Name*
Company
Address*
City:*
State
IN
KY
MI
OH
Zip Code*
Your Main Phone Number:*
(
)
-
Daytime Phone Number:
(
)
-
E-mail:
Are you interrested in Business or Home Services?
Business
Home
How many telephone lines do you have?
Who is the current Provider of your services?
ATT
TDS
Verizon
Level 3
Verizon
CenturyTel
TalkAmerica
KMC
Other
How many workstations do you plan on connecting?
1
2-5
6-10
11-15
16-20
More than 20
What is your current connection type?
DSL
T1
T3
Other
How did you hear about ACD.net?
Please Select
Mailer or Flyer
Yellow Pages
Newspaper Ad
Newspaper Insert
Word of Mouth
Television
Radio
Billboard
Internet
*Denotes required information.
Copywrite 2022 ACD. All rights reserved.