Lansing Area DSL and Phone Order Form

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Residential Order Form

Please fill out the order form to the right to place an order for High Speed DSL Internet, Bundled or

home Phone service in the East Lansing or Lansing Area.

Internet Options

Faster and more Reliable than cable modem service these High Speed DSL Internet options are sure to keep you surfing.

Internet Essentials
Internet Direct
Internet Express Premium

Bundle Options

Bundle your Internet and Telephone Service and

get an even better deal!

Bundled Local Essentials
Bundled Express Unlimited

Telephone Options

Don't have a computer? Using all of your minutes calling home? Sign up for Arialink home telephone service and save those minutes for your friends.

Unlimited Local Calling
Unlimited Local\Long Distance Calling

Sign up today to get a FREE modem. All pricing is per month, with a minimum 3 month contract, after 3 months the agreement is month to month.

Once you have submitted your order a Representative will contact you within 24 hours. By submitting this form you agree to pay your monthly bill thru auto-pay, your bill will automatically be deducted from the credit card provided.

Service Address

Name

Address

Apt #

City, State

Zip

Telephone

Billing Address

Name on Credit Card:

Address:

Apt #:

City, State

Zip

Type of Card:

Credit Card #:

Expiration Date:

Product Selection

Product:

Associate:

If you had assistance from an Arialink representitive, or were left a doorhanger with a sales associates name on it, please type the associates name above.

I hereby agree by submitting this form that my first months bill along with any activation or equipment fees will be charged on the day I receive service. This date will become my Monthly Bill Date and will be the day I am charged each month from then on. A Monthly Statement will be available for me to view online thru Arialink Epay service. If I wish to cancel my service, I must alert Arialink 30 days prior to the cancellation date.

I agree to the above conditions as well as the Arialink Terms and Conditions.