WINspeed DSL Order Form

Complete this form to order WINspeed DSL Internet service. Please leave a phone number and best time to call so that we may complete your order. Once you hit submit this order will be emailed to our customer serivce team.

Name:
Address:
City:
State:
Zip Code:
Phone:		Best Time to Call:
Secondary Phone:
email:
I would like to sign up for:
256K	$29.99/mo
1MB	$39.99/mo
1MB - Carroll Residents	$29.99/mo
3MB - Carroll Residents	$39.99/mo
3MB - Breda Residents	$49.99/mo
5MB - Carroll Residents	$49.99/mo
5MB - Breda Residents	$59.99/mo
10MB - Breda Residents	$99.99/mo
SecureIT Services	$7.99/mo - $10.99/mo
Online Backup	$2.95/mo - $14.95/mo
Lease Modem/Surge Protector	$5.00/mo
Purchase Modem/Surge Protector/Wireless Router	$79.99ea
Internet requires $50 activation fee. Speeds are not guaranteed and may vary depending upon your location.

Preferred User Name:	15 character MAX, three character minimum--no “&” sign or symbols, must begin with a letter
Additional Emails:	You are allowed up to 5 emails, with the @westianet.com domain.

Additional Questions/Comments:

Western Iowa Networks

Internet Services

Internet Support

WINspeed DSL Order Form