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* Indicates a required field      * First Name MI * Last Name * Social Security No  (numbers only, no dashes) Service Address * Building 3900 Chestnut Street  * Apartment   * Lease status  Tenant  Subtenant Lease Start  (format MM/DD/YY) Lease End  (format MM/DD/YY) Billing Address (if different) Billing Address 1 Billing Address 2 Billing City Billing State AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Billing Zip Contact details * Email Cell Number  (numbers only, no dashes etc) Permanent phone #  (numbers only, no dashes etc) Services Ordered Budget Telephone  at $12.95 per month, $29.95 installation Unlimited Telephone  at $39.95 per month, FREE installation Standard 3 Mbit Internet  at $39.99 per month, FREE installation Xtreme 100 Mbit Internet  at $59.99 per month, FREE installation Final Order details * Date service requested  (format MM/DD/YY) Special instructions * Confirmation By clicking the ‘Submit’ button below I confirm that I have read and agree to comply with Phillynet’s Terms and Conditions and Acceptable Use Policy set out here.

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