tcn
Internet Access Application Form
Please complete the
Internet Application Form
in full and submit. All information will be confirmed by a customer service representative, prior to the set up of your account.
Personal Information
First Name:
Last Name:
Company Name:
Street Address:
City:
Province:
ON
AB
BC
MB
NB
NF
NS
PE
PQ
SK
NWT
YK
Postal Code:
Phone:
Fax:
Username:
@tcn.net
Password:
Billing Frequency:
3 Months
12 Months
OS Type:
Windows XP
Windows 2000
Windows 95
Windows 98
Windows NT
Macintosh
OSX
Linux
Unix
Service:
Residential High Speed 1.0 mb
Residential High Speed 3.0 mb
Business High Speed 1.5 mb
Business High Speed 1.5 mb Static IP
Business High Speed 3.0 mb
Business High Speed 3.0 mb Static IP
Residential Dial Up
Business Dial Up
Business ISDN
Additonal Information or Comments
