CenturyLink ILEC Internet | Request New Service | Intelligent Technical Solutions

CenturyLink ILEC Internet - Request New Service

Customer H Number:*
Account Name:*
Requested Due Date:*

Date Format: MM slash DD slash YYYY
Internet Service Package / TERM:*
Select Internet Service Speed / Contract Length / Price
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:*
Service Zip Code:*
Local Contact Name for Installation:*
Local Contact Phone Number:*
Billing
Billing:*
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:

Phone
This field is for validation purposes and should be left unchanged.