DSL Prequalification Form All information collected will be used only to determine what DSL service is available at your location, to process your order should you decide to go ahead with DSL service, and to communicate setup instructions. Personal Contact Information First and Last Name: DSL Street Address: City, State and ZipCode: Contact Telephone Number: DSL Circuit Telephone Number: E-mail address: If your telephone service is provided by Century Link, there is an a 3-digit number with a letter which appears after the telephone number on your telephone bill. We will either need that or the last four digits of your social security number in order to prequalify your telephone line for DSL. Account Verification Code: Login Credentials Your login May contain only the following: [a-z], [0-9], “-“, and “_” Must NOT START with a dash. Must contain at least one non-numeric character. Must not exceed eight characters. Is your e-mail address here at Eskimo North. Remains your login name after the trial as well. Login: Your password: Must be different from your login. Must be least five characters long. May contain any printable character. UPPER and lower are different. Password: Account Options Add a 56k dial up connection (roaming access) for $4/month? Where Where did you hear about Eskimo North?