Frontier DSL Data Sheet

Filling out this form sends the appropriate information to us for qualifying your Frontier phone line for the DSL Service.

Instructions:

  • Fields marked with a red * are required.

  • In the name and address boxes please supply us with follow-up contact information. Address should be the the physical address where your phone is located (no PO Boxes please).   Include Apartment number on requests of Stand Alone DSL (Internet with no phone service)

  • In the DSL Phone Number field enter the phone number, starting with area code, that you would like to have your DSL service added to. Remember that DSL runs over the same phone line you are currently using without interfering with your normal voice phone service.

  • Please supply the name under which Frontier bills the phone number you wish to have DSL added to. If this is the same name as you have given us for contacting you then you may leave this field blank.

  • If you have 6 or more phones (or faxes) and/or an alarm system connected to the phone lines you will need special installation services.  Please note this in the form below.

  • If you are not comfortable with the setup for your computer we can arrange for a service technician to do this for you.  Please note this in the form below.

  • There is currently a 8 day lead time on Frontier DSL Installations.

*First Name:
* required
Middle Initial:
*Last Name:
Company:
*Address:
Apt Number/Address (cont):
*City:
*State:
*Zip:
*Email Address:
*Home Phone:(419)xxx-xxxx
Work/Cell Phone:(419)xxx-xxxx
Fax Number:(419)xxx-xxxx
I will need special
installation services:		 NO
YES
I would like a service person
to set-up my computers:		 NO
YES
*DSL Phone Number:(419)xxx-xxxx
(phone number having DSL added to it)
Stand-Alone
(no phone number):		 NO
YES
Location is:
DSL Service Level:
Name on Phone Bill:
(May be left blank if same as name above)

* required