DSL Interest/Request Form


If you live in one of the areas where DSL is currently available, and are interested in getting the service, fill out the fields below and someone will contact you.

NOTE: Only people whose local phone service provider phone company is Tidewater Telecom/Lincolnville Communications or Verizon should fill out this form.
First Name: 
Last Name: 
Type of location:
Business Name:

Physical Address
For DSL Service
Street Address:
City, State, Zip:
Contact Phone Number: 

Phone Number
For DSL Service:
Local Phone Service Provider:

For Verizon Area ONLY:

I'm interested in Regular DSL Platinum DSL
Current Email Address: 

Number of phone extensions that share the DSL number:
Number of computers to be connected to DSL:
Notes: