Access Point Deposit Request Form
  * = Required field  
Name:  *  *
Phone Number: ( ) -
Cell Phone Number: ( ) -  *
E-mail Address:  *
Address:  *
Apartment/Unit Number:  *
Reason for Request:
Mailing Address (For the cheque):  *
City:  *
Province/State:  *
Postal Code/Zip Code:  *
Country:  *
Subscription Period: Start date:  *
Length:  *
Enter the text in the box:
  1. Please fill in all of the required information to proceed.
  2. Once the form has been submitted, a technician will contact you to set an appointment to test and pick up the access point.
  3. Once our technician has verified that the access point is in working condition, we will send a cheque to your mailing address by the end of next month.