Internet Request Form

All Fields highlighted(*) are required fields.

*First Name:

*Last Name:

*Email:

*Phone Number:

*Work Number:

*Mailing Address

Service Address - City, State, Zip

* If different that mailing address

Business

Residential

Up to 15Mbps

Up to 25Mbps

Up to 40Mbps

Up to 50Mbps

Up to 75Mbps

Up to 100Mbps

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125 E. Fletcher, P.O. Box 25
Haxtun, CO 80731

Business Office (970) 774-7611
Toll Free: (800) 468-8087

information@haxtuntel.net