DSL Online Qualification Form

Do you have an exisitng account with Innovative PowerNet? Yes No
If yes:
Account Name:  		and / or User Name:
Residential Business Government Bronze Silver Gold

*Please supply correct Email address to receive the copy of this form
Name: Email Address: *
Customer Home Phone:  Work Phone:

Mailing Address:
Address:
 City:
Island:
 Zip:

Phisical Address:
Address:
 City:
 Island:
 Zip:

(Businesses Only)
Bsnss Lic Nmbr :
 Tax ID#
PR# (Govt. Only)

** Note: Customer must give a telephone number for DSL service. Ethernet NIC is required for your PC (s) / Telephone filter may be required. Note: Some one will contact you with in 48 hours about your qualification request. Telephone number for DSL service:**


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