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USFamily High Speed Internet Access Service Request

Online Order Form - Qwest Stand Alone (1.5M) DSL Residential Service Only

USFamily.Net is happy to handle all of the details of ordering highspeed Internet access & DSL service for you. If you are interested in ordering service for a different DSL speed, click here to visit our DSL information page

Please note, a one-time $9.99 activation fee for Stand Alone DSL is billed by Qwest on your first DSL service bill.

Please take a few minutes to simply fill out the information below and click on the submit button.

STEP 1: Select your order type:

Order Type:	Residential
	Business

STEP 2: Enter your personal information:

Is Qwest your home telephone provider?
First Name:
Last Name:
Street Address:
Apt / Suite No.:
City:
State:
Zip Code:
Home Telephone Number : This should be the number you would like DSL service on. For Stand Alone DSL, please enter a contact number.	(enter numbers only 5555551234)
Contact (Cell or Work) Phone Number:
E-mail Address:
Best Time to Call:

The following information is required for Stand Alone DSL
Date of Birth (mm/dd/yyyy)
Social Security Number (xxxxxxxxx)
Employer (If they are a student or not employed enter "other".)
Previous Street Address
Previous Apt / Suite No.:
Previous City:
Previous State:
Previous Zip Code:

STEP 3: Enter information about your home telephone equipment:

In order for DSL service to work with the other telephone devices in your home, it is necessary to place a microfilter on each telephone device being used in your home.

In order to send the correct amount of microfilters, it is important that we know what equipment is connected to the line that will receive Qwest DSL service. Please enter the correct numbers below:

How many wall mounted telephones are currently being used in your home*?
Click here to see what a Wall Mounted Telephone looks like? (a new window will open)

How many other telephone devices are being used currently in your home*?
(Please consider all other telephones, answering machines, fax machines, satellite connections, home security systems, utility monitoring devices or other items plugged into your phone outlets).

*A package of 1 wall mount microfilter and 3 desk microfilters are included with your modem at no additional charge.

Additional filters will be provided by USFamily.Net at an additional cost:
Price for each additional desk microfilter is $5.00.
Price for each additional wall microfilter is $7.50

STEP 4: Select how to pay for your DSL modem:

Modem Option	Price
Rent Non-Wireless	$5.00 per month
Purchase Non-Wireless	$59.99
Rent Wireless	$7.50 per month
Purchase Wireless	$79.99
Own†	$0.00

STEP 5: Select Modem Shipping and handling

Modem Shipping Option	Regular Price
USPS Priority Mail Shipping	$9.99
Pick-Up Modem at USFamily.Net Offices	$0.00
None - I already own my modem	$0.00

All modems are provided and billed by USFamily.Net. Sales tax not included.
Modems are shipped via USPS Priority Mail service and will arrive on or before your scheduled activation date.
† You are responsible for making sure your DSL modem is compatible with Qwest service.

STEP 6: Select if you would like any wireless cards/adapters:

Qty	Wireless Card/Adapter Type Click for more details	Cost
	USB Adapter	$49.99

Only available here for customers purchasing or renting a modem from USFamily.Net.
Wireless cards will be shipped with modem at no additional shipping costs.
If you would like to purchase a wireless card without a modem, please visit our online catalog to purchase.

STEP 7: Select an installation method:

Don't know which installation method to choose?
Click here to figure our which method is right for you (a new window will open up)

Installation Method	Pricing
Self - Customer will install and configure the Qwest DSL Modem hardware & software.	$0.00
Plug & Play Installation - Modem will arrive fully configured and ready to go, all you have to do is connect it to your computer. Available for customers connecting their modem via ethernet only!	$19.95 + Sales Tax
Professional Installation - A USFamily.Net technician will be sent to your home or business to install and configure the necessary hardware and software for DSL service	~~$79.99 + Sales Tax~~ LIMITED TIME SPECIAL $49.99 + Tax

STEP 8: Enter a special code:

If you received a special code from an advertisement or from an organization you would like to support, please enter it below. If you do not have a special code, please skip ahead to Step 7.

Special Code:

STEP 9: How did you find out about USFamily.Net High Speed DSL:

STEP 10: Order Notes
If there are any notes or additional information for this order, please enter it here:

STEP 11: Submit your DSL order request: