If you have more than one address on Fire Island (home or business), please fill out this survey for EACH address separately.

* 1. First Name

* 2. Last Name:

* 3. Fire Island Address

* 4. Home or Business Telephone Number:

* 5. Mobile or Alternate Telephone Number:

* 6. Email Address:

* 7. What type of location is the address above?

* 8. Are you a year round resident or seasonal resident?

* 9. What service(s) do you currently subscribe to (check all that apply)?

* 10. What product(s) are you interested in?

* 11. If you selected a fiber-based solution, do you approve the pre-positioning of the fiber optic cable to your home or business? This would entail the wire running from our telephone poles and connecting it to your location. This will speed up the ability to have service activated once the network construction is complete.