USA Choice Wireless Signup

Pre-Signup Form

    First & Last Name
    Address
    City
    Phone Number
    E-Mail Address

Questions

       
    1) Do you own a computer?   Yes No
    1a) If yes, how many?  
     

    2.)

    		 Do you currently have an Internet Provider?
    If Answered YES, how do you connect?    		 Yes No
    Dial-Up Cable DSL Satellite

    3.)
    		For what reason do you connect to the internet? (check all that apply)
    Browsing E-Mail
    Business Stocks/Investing
    Music/Video Digital Pictures
    Research Banking
    Shopping/Ebay News/Weather
    Homework Chatting/IM
    Games Other

    4.)
    		Would a faster internet connection improve your Internet activities?   Yes No

Captcha

    The CAPTCHA image
    Phonetic spelling (mp3)     		Enter the letters you see to the right:
    		   
YES, I am interested in signing up for USA Choice Wireless