Request Order Assistance

	Please complete this form to request order assistance and an Atlas service Representative will contact you to assist. NOTE: FIELDS WITH AN * ARE REQUIRED - SELECT 'NONE' IF YOU DO NOT WANT THE SERVICE.
First Name (*)	Invalid Input
Last Name (*)	Invalid Input
Email Address (*)	Invalid Input
	Provide information about your Suncadia or Tumble Creek Residence:
Development	Invalid Input
Residence Type	Invalid Input
Street Address (*)	Invalid Input
Type	Invalid Input
	------------------------------------------------ Please note: installation is not started until the setup invoice is paid. INSTALLATIONS GENERALLY REQUIRE 4 TO 8 WEEKS FROM THE PAYMENT DATE TO BE COMPLETED. Thank you for your understanding.
Installation Type	Invalid Input
	Provide information about your primary residence if other than Suncadia/Tumble Creek. Otherwise, leave blank.
Alternate Address	Invalid Input
Alternate City	Invalid Input
Alternate State	Invalid Input
Alternate Zip	Invalid Input
Alternate Telephone #	Invalid Input
Billing Method	Invalid Input
Invoice Delivery	Invalid Input
	------------------------------------------------ Customers that select a phone, internet, and TV service will receive a 5% discount on the three services.
Select Phone Package	No Phone Basic Phone (No Long Distance Included) - $29.95 month Enhanced Phone (500 Long Distance Minutes) - $39.95 month Premium Phone (Unlimited Long Distance) - $49.95 month Fax Line (Unlimited Local) - $18.95 Invalid Input
Select number location for telephone line	Invalid Input
Select Secdonary Phone Line	No Phone Basic Phone (No Long Distance Included) - $29.95 month Enhanced Phone (500 Long Distance Minutes) - $39.95 month Premium Phone (Unlimited Long Distance) - $49.95 month Fax/Alarm Line - $18.95 Invalid Input
Select number location for second telephone line	Invalid Input

Internet Package	No Internet Basic 3Mbps Down/3Mbps Up - $39.95 month Enhanced 10Mbps Down/5Mbps Up - $49.95 month Premium 25Mbps Down/5Mbps Up - $79.95 month Ultimate 50Mbps Down/10Mbps Up - $99.95 month Invalid Input
	Internet Firewall & Router. You can connect to the internet without a firewall. However, we strongly advise that you install a firewall for your home to help protect your computers and home network. There are three options: 1) Purchase and provide your own 2) Purchase a firewall from Atlas 3) Rent a firewall from Atlas, which includes unlimited support, configuration and free hardware replacement.
Internet Firewall Router	Invalid Input	* Wireless may not cover the entire home and require one or more additional wireless access points.
Static IP Address	Yes - $2.00 mo. Invalid Input

Television	No Television DirecTV Choice Package + HBO - $69.95 month Invalid Input
First Set Top Box Type	Invalid Input
Additional Standard Definition Set Top Boxes	Invalid Input
Additional Hi Definition Set Top Boxes	Invalid Input
Additional Information	Invalid Input

Please enter the following text:	Invalid Input