name:
	email:
	address:
	city:
	province:
	postal code:
	phone number:
	service type:	$39.95 - Standard SURF $69.95 - Business SURF *
	modem rental:	Yes - $9.00 a month No - I have my own I would like to buy a modem! *
	lfs customer:	Yes - I am a customer No - I am not a customer

* One time activation fee applies of $19.95. Tech support is only available for rented / purchased    SpeedSurf modems. We cannot offer support for non-SpeedSurf modems.