Online Service Order Form
By filling out the form below, you are placing an order for Amigo.Net wireless broadband internet service. Service availability is subject to distance, terrain and location.
Items with a red asterisk (*) are required.
Mailing Address (if different than physical address)
Company Name
* First Name
* Last Name
* Daytime Phone Number
Fax Number
* E-mail Address
* Street Address (no P.O. boxes)
* City * State CO NM NV
* 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
$99 (12 month commitment)*
$80 basic $180 VPN $0 none
$34.95
$79.95
$150.00
$250.00
Enter promotional code if any in the block provided below.
Check this box to indicate that you have read and agree to the Terms and Conditions of Amigo.Net broadband internet service:
An Amigo.Net 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 dial up 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 Amigo.Net. A representative will contact you by phone to confirm your order and make payment arrangements.
