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* 1. First Name

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* 2. Last Name

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* 3. Address 1

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* 4. Address 2

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* 5. City

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* 6. Zip

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* 7. Best number to reach you?

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* 8. Email Address

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* 9. Would you be willing to sign a 24 month contract? If no, construction fees may apply.

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* 10. What Unlimited Internet package would you like to signup for?

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* 11. Would you like to add any additional services? For more information about these services visit the links below.
https://www.etex.net/whole-home-wifi/ 
https://www.etex.net/services/digital-tv/

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* 12. Did you pay the $50 commitment online?

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* 13. Do you own or manage a Business in the White Oak area?

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