CenturyLink ILEC Internet - Request New Service Customer H Number:* Account Name:* Pomeroy Requested Due Date:* Date Format: MM slash DD slash YYYY Internet Service Package / TERM:* Select Internet Service Speed / Contract Length / Price Choose an item512K/256K - 2 Years - $54.99512K/256K - Month to Month - $69.99768K/384K - 2 Years - $54.99768K/384K - Month to Month - $69.991.5M/512K - 2 Years - $54.991.5M/512K - Month to Month - $69.993M/640K - 2 Years - $54.993M/640K - Month to Month - $69.995M/768K - 2 Years - $54.995M/768K - Month to Month - $69.996M/512K - 2 Years - $54.996M/512K - Month to Month - $69.998M/768K - 2 Years - $54.998M/768K - Month to Month - $69.9910M/768K - 2 Years - $54.9910M/768K - Month to Month - $69.9910M/1M - 2 Years - $54.9910M/1M - Month to Month - $69.9912M/1.5M - 2 Years - $64.9912M/1.5M - Month to Month - $79.9912M/5M - 2 Years - $64.9912M/5M - Month to Month - $79.9915M/768K - 2 Years - $64.9915M/768K - Month to Month - $79.9915M/1.5M - 2 Years - $64.9915M/1.5M - Month to Month - $79.9920M/1.5M - 2 Years - $64.9920M/1.5M - Month to Month - $79.9920M/5M - 2 Years - $64.9920M/2M - Month to Month - $79.9925M/2M - 2 Years - $84.9925M/2M - Month to Month - $79.9940M/5M - 2 Years - $84.9940M/5M - Month to Month - $99.9940M/20M - 2 Years - $84.9940M/20M - Month to Month - $99.9950M/5M - 2 Years - $154.9950M/5M - Month to Month - $99.9960M/5M - 2 Years - $154.9960M/5M - Month to Month - $99.9960M/60M - 2 Years - $154.9960M/60M - Month to Month - $99.9980M/10M - 2 Years - $154.9980M/10M - Month to Month - $99.9980M/40M - 2 Years - $154.9980M/40M - Month to Month - $99.9980M/80M - Month to Month - $99.99100M/100M - 2 Years - $154.99100M/100M - Month to Month - $169.99200M/200M - 2 Years - $174.99200M/200M - Month to Month - $189.99300M/300M - 2 Years - $204.99300M/300M - Month to Month - $219.99400M/400M - 2 Years - $204.99400M/400M - Month to Month - $219.99500M/500M - 2 Years - $204.99500M/500M - Month to Month - $219.991Gig/1Gig - 2 Years - $254.991Gig/1Gig - Month to Month - $269.99 Service Site Information Service Street Address:* The street address of the site where internet service will be activated. Please include Suite and/or Unit numbers Service City:* Service State:* Choose an itemAKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMIMNMOMSMTNCNDNENHNJNMNVNYOHOKOROTHERPAPRRISCSDTNTXUTVAVTWAWIWVWY Service Zip Code:* Local Contact Name for Installation:* Local Contact Phone Number:* Billing Billing:* Paperbilling Order Document Upload Order Form:* Form document must be file extension .doc or .docx You can download the order form template here. Accepted file types: doc, docx. Additional Information List any Additional Features or Blocks desired: Comments and Special Instructions: Comments This field is for validation purposes and should be left unchanged.