Premium Business DSL Order Form

Please make sure you have checked the Availability in your area, and that you are under 16,500 feet from the Central Office. 128k IDSL is available for customers between 16,501 and 18,500 feet from the C.O.

If you have any questions or are unsure of a certain field,  please call 973-285-9099 or email dsl@gti.net.  All DSL service has a one year term.

All fields marked with a * are required.

Company Name	*
Primary Contact Name	*
Site Name (if any)
Street	*
Floor	*
Suite/Room	*
City	*
State	*
Zip Code	*
Phone (Main phone number at above address)	*
Fax	*
Alternate Phone (if any)
Pager / Cell Phone (if any)
Email
Secondary Contact (if any)
Secondary Phone
Secondary Fax
Secondary Email
Secondary Pager/Cell
Zip Code
Phone
Email
Line Speed Desired	128K 256K 384K 512K 640K 768K 1.1 Meg 1.5 Meg *
Location of Jack for DSL.  (i.e. telephone closet, computer room, etc.)	*
Will you require Network Address Translation? (NAT)	Yes No
If you do require NAT, how many IP addresses will you require for your network? (Typically 1 per machine, and leave a 5-10 extra IP's for expansion)	8 16 32 64 128 256
If your network currently uses NAT, please input your IP addressing scheme (i.e. 192.168.1.1, 10.1.0.1).  To find out more click here.
Questions / Comments
How did you hear about GTI?
Do you agree to our Terms of Service?	No Yes *

Questions? Call 800-496-4841 x105