Secure Online Signup Form

To initiate your new Drizzle DSL account, simply fill out the form below. We will let you know when Qwest and Verizon connections have been established.

You do not need to submit any credit card information to see if you qualify for DSL. Simply fill out the first part of the form, submit it and we'll get back to you regarding your qualification status.

Account Information
Drizzle DSL
Username
Password
Who Referred You?
Customer Information
Customer Name
Company Name
Street Address
City
State
Zip Code
Home Phone Number
Work Phone Number
FAX Number
Current Email Address if any
Comments
Credit Card Information
Name on Card
Street Address
City
State
Zip Code
Card Type
Card Number
Security Code (CVV)
Expiration Date	/ / month/day/year
May we keep this card number on file for future renewal charges?

You will receive an order confirmation via e-mail

Drizzle DSL Terms and Conditions