Help us bring broadband to you.

Completing this form helps demonstrate the need for the WiredWest network in your town. The more support generated, the sooner we can build the network in your area.

We do not have precise costs for the services we will offer, but we do know prices will be competitive with rates for these services here and elsewhere.

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Desired Services

Check each of the services you would like to get:

High-speed Internet      Phone      TV / Video     


First Name:

Last Name/Business Name:

Mailing Address

Address 1:

Address 2:


State:    Zip:

Street Address

Address 1:

Address 2:


This street address is a:

Residence / Home Business     Business only

Phone - Email

Landline Phone:

Mobile Phone:



Yes, Please add me to the WiredWest email list so I can be informed about WiredWest progress and activities.

I understand that although this is not a contract, submitting this form shows that I am seriously interested in taking services on the WiredWest network when it's available in my area.

WiredWest will not share your personal information.

Please check the checkbox above to activate the Submit button.