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INTERNET + HOME PHONE + LONG DISTANCE

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Step 1: Plan Selection
	Please choose one of the unlimited plans
	Please select Phone Number option
	Porting Number*
Personal Information
	* First Name
	* Last Name	Initials
	* Street Name & Number	* City
	Apartment/Unit Number
	Province	Country
	* Postal Code
	* Contact Number
	* Email address:
	*Confirm Email address:
	Agent/Reseller Information
	* Reseller Name
	* Business Name
	* Business Location/Address
	* Business Contact

	Remarks
	* Required Field

Credit Card Information (Optional)
	Card Name:
	Name on Card Card:
	Credit Card Number:
	Expiry Date:
	Security Number:

	Enter Verification Code


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