High-Speed Internet Upgrade Request Form
Full Name
Address
Email Address
Phone Number
Current Internet Speed
Below 10 Mbps
10 - 50 Mbps
50 - 100 Mbps
100 Mbps or higher
Requested Upgrade Speed
50 Mbps
100 Mbps
200 Mbps
500 Mbps
1 Gbps
Reason for Upgrade
Additional Comments