Service Availability Request

Rural Tech Solutions Service Request
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address (Service Address)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you requesting service for Indian Acres?*

YesNo
Please select your glen number :
Please enter your lot number :
Type of Service Requested? (Select all that apply)*

Residential ServiceBusiness SerivceBusiness Backup ServiceDigital Voice
How would you describe your typical internet usage? (Select all that apply)*

Casual BrowsingEmailStreamingGamingTeleworkVPN RequiredTeams / Zoom Meetings
Who is your current internet service provider?*

Satellite Provider (Hughes, ViaSat, Etc.)LTE/5G HotspotVerizon DSLNo Current ProviderOther
How would you rate your current provider?
Should be Empty:

Rural Tech Solutions Service Request