This form is no longer used for Residential orders as of Oct 2019.

The new Residential DSL and phone service order form can be reached following this link.



Please enter your Personal Information

To determine if the service you are interested in is available at your address, please enter the following information:

Type of service:

First Name:

Last Name:

Street Address:

Apt/Ste/Flr:  

City:

State:

Zip Code:
  Contact (Work or Cell) Number:  
  E-mail Address:  
  Best Time to Contact:  

Are you interested in switching your current phone service, or establishing new service all together?

Is Centurylink (legacy Qwest) Telephone service currently available in your area?
  Current Telephone Number:
(enter numbers only 5555551234)		  

Who is your current telephone provider*?
 

*If your current telephone provider is not listed in the drop down menu above, please be sure to specify your current provider in the notes section at the end of your order.

  

Who is your current Internet Provider?

How did you hear about Velocity?

ã 2006 Velocity Telephone, Inc.