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Qwest Instant Signup

After you have completed this form, a line check will be done on your telephone number via Qwest and a DSL-Only representative will get back to you with the results. This should take ~72 hours to complete.

Your Name:

Business Name:(if app)

Street Address:

City:

State:

Zip Code:

Home Phone:

Work Phone:

Business Hours:

Email Address:

Referred By:

Type of Service:

Service Requested:

Qwest Agreement Length:

Do you have a DSL Modem:

If yes, what kind:

If No, Select Modem type to order:

Physical Location of Phone Line: (Home, Apt, Etc.)

Phone Number to Receive Service:

Number of Phones Using Number:

Place Order with Qwest if Linecheck is good?:

Computer Type:

Operating System:

Existing Ethernet Card:

Account Type:

Additional IP Addresses needed:

Additional mailboxes needed:

Additional Comments or Questions:

Check the box to acknowledge that you have read and accept the Billing and Acceptable Use Policies. To Read our Policies Click Here.

Fine Print (Required by Qwest to satisfy Public Utility Commission requirements)

I do hereby appoint DSL Only, Inc. or their authorized agents as agent for the limited purpose of ordering and implementing Qwest MegaLine service on the phone number listed above. This includes changes in and/or maintenance on service(s) provisioned in this order including, without limitation, removing, adding to or rearranging such service. Qwest is hereby released from any and all liability for making pertinent information available to "DSL Only, Inc. or their authorized agents and for following their instructions with respect to any changes to or maintenance on the service(s) provisioned in this order. You may deal directly with DSL Only, Inc. or their authorized agents on all matters pertaining to service(s) provisioned in this order and should follow instruction with respect thereto. This authorization will remain in effect until modified or rescinded in writing.