Dedicated Access Pre-Qualification Form

Please use this form to provide us information necessary to pre-qualify you for HCST*Net Dedicated Access Services, including ISDN, T1 and  DSL Services. At this time, HCST*Net does not provide residential ADSL services. Our staff will analyze your request and respond promptly with information on the requested services.

Name:
Company:	(required for business connections)
Address:
City:
State, Zip:
Phone:	(at the installation address, required)
Fax:
E-Mail:
Interested in:
	Business DSL Residential/SOHO DSL Dedicated ISDN ISDN (demand) Dialups Burstable T1 (check all that apply)
Comments: