You have chosen to purchase a Syban High Speed Wireless Internet account

 Contact information:


 Fields marked with a * are required.
 
* First Name: * Last Name:
Organization: * Address:
* City: * Province:
* Country: * Postal Code:
* Phone: * Email address:
Quarter Section: Section:
Township Number: Range Number:
Meridian:    


 Comments:

Please provide some driving instructions to your house as well as your legal land location if it is different than your mailing address. Be advised that it takes us up to 24 hours to look at your order form and determine if you can get the service or not. If you haven't heard from us after 24 hours, please call us back at 1-800-679-0345. As well, if you would like to send us any further comments or instructions, please add them here. Thanks.