Midcoast Internet Solutions

Business Internet Phone Service
Inquiry/Order Form

To proceed with the service ordering, please fill out the fields below and someone will contact you to schedule the service installation.

	Existing Number to move (xxx-xxxx)
Service Address
Street Address:
City
Zip:
Billing Address
First Name:
Last Name:
Company:
Street Address:
City
Zip:
Features. Pick two of the following:	Yes No - Call Waiting Yes No - Call Forwarding Yes No - Call Forward Busy Yes No - Call Forward Do Not Answer Yes No - Selective Call Acceptance Yes No - Automatic Call Return Yes No - Line Blocking Yes No - Three Way Calling Yes No - Selective Call Forwarding Yes No - Selective Call Rejection Yes No - Anonymous Call Rejection Yes No - Repeat Dialing
Caller ID with Name ($3/month):	Yes No
3rd Party Billing Block:	Yes No
Collect Call Block:	Yes No
International Call Block:	Yes No
Intrastate Block:	Yes No
Interstate Block:	Yes No
Caller ID shall display:	(Up to 15 characters)
Contact Phone Number:
Current Email Address:
Current MIS broadband customer?:	Yes No
Equipment Choice

Notes:

594-8277
25 Oak Street
Rockland
Contact
Midcoast Internet Solutions
563-8563
7 Hall Street
Newcastle