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Items with a red asterisk (*) are required.
Company Name
* First Name
* Last Name
* Daytime Phone Number
Fax Number
* E-mail Address
* Street Address (no P.O. boxes)
* City * State CO
* ZIP Code
First Name
Last Name
Daytime Phone Number
E-mail Address
Mailing Address (P.O. boxes are fine)
City State AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA DC WV WI WY
ZIP Code
*installation fee originates from Qwest. Amigo.Net has no installation fee! Qwest prices are subject to change without notice.
Please select Qwest Actiontec DSL option*: Rent Modem Purchase Modem Own Modem Please enter the last three numbers of your Qwest Account Number*: *A Qwest DSL modem will be required for service in most cases. You may rent or purchase this modem from Qwest. A $5 per month charge will appear on your monthly Qwest phone bill for modem rental, or a $59.99 charge will appear on your bill for modem purchase. These prices are subject to Qwest terms and conditions and are not under the control of Amigo.Net, as they may change without notice.
*The last four digits of your account code are found on the upper right corner of your bill (i.e. 555-555-5555-789b).
An Outlaw DSL representative will call you to ensure that everything is in order before asking for payment over the phone. Please check the payment method you anticipate using:
I'll submit a credit card I'll submit a check I'm already a dialup customer, bill me later using my registration number:
If an authorized reseller informed you of our service, please enter the reseller's name here:
Press the button below to submit the order to Outlaw Wireless. A representative will contact you by phone to confirm your order and make payment arrangements.
