Internet Inquiry Form by Lara Internet

Your Name (required)

You Address (required)

Apt #

City (required)

Province (required)

Postal Code (required)

Your Email (required)

Telephone (required)

The Address is: (required)
ResidentialBusiness

Do you have an active analog phone Landline on your premises?
YesNo

Do you have Cable Internet now?
YesNo

If Yes , what service provider are you using?

Are you interested in Unlimited Data?
YesNo

Please check what speeds you are interested in Low
Low (under 20 Mbps)Mid (between 20 Mbps- 50 Mbps)High (60 Mbps +)

Do you need an email address from us:
YesNo

If yes, How many?

For Business Clients Only: Are you interested in Domain Web Hosting
YesNo

How did you hear about us? (required)
Internet SearchFlyersFacebookYellow PagesOther

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