Customer Service Order Form for National Tech Solutions LLC

Customer Service Order Form for National Tech Solutions LLC

Complete this form to request your internet and telecommunications services.
Customer Information
Full Name

First NameMiddle NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Service Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Is this address different from the billing address?
Billing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Service Type
Are you ordering for
Company Name
Number of Employees
Service Selection
What type of service are you interested in?
Preferred internet speed
Installation & Scheduling
Preferred installation date

MonthDayYear
Date
Preferred time window
Any special instructions for the technician?
Current Provider
Do you currently have internet service?
Who is your current provider?
Reason for switching
Additional Notes & Consent
How did you hear about us?
Additional comments or questions
Consent to be contacted by National Tech Solutions LLC via phone or email regarding my order
Confirmation of information accuracy
Should be Empty: