Surf and Sip™ Internet-Cafe-In-a-Box
Please fill out the following form to qualify to become a Surf and Sip Location. Required fields are in red. We will contact you by telephone after your application has been processed and approved for further information and payment.
First Name
Last Name
Venue Name
Email Address
Address Line 1
Address Line 2
City
State/Province
Zip/Postal Code
Country
Phone
Fax
Venue Type Cafe Bar Restaurant Hotel Airport Marina Library Internet Cafe Other
When do you want to go live with Wifi?
Which Type of Service Do You Want to Offer? Free Fee
Number of locations?
Venue Description For Your Website Listing (250 words or less)
I don't currently have a high-speed connection. Please help me order one.
DSL Phone Number
DSL Phone Number Provider
Connection Type --- DSL Cable T1 ISDN Two Cans and a Wire Other Don't Know
IP Type --- PPPoE PPPoA Static DHCP Don't Know
DSL Provider
PPPoE Username
IP Address (If available)
PPPoE Password
Router/Gateway Address (If available)
Modem Type
Subnet Address (If available)
Comments
