Panix - Pioneering Internet services since 1989    

Panix T1 Order

Please do not fill out this form until you are ready to place an order. Upon receipt of this order submission, we will send you a completed contract. Your leased line will be ordered upon receipt of the signed contract.

If you have any questions about filling out this form, please feel free to contact us.


Service level Billing cycle


Do we need your billing information?

Please add this to my current bill (you will be asked to authenticate)
New billing record supplied here
  Company
Name
Street address
City State
Country Postal code
Daytime phone Non-US numbers should begin with a '+'
  Evening phone
Email address

Installation and administrative contact information

To speed processing of your order, please enter address information exactly as it appears on your telephone bill.
Name
Street address
City State Zip code -
Installation phone For DSL orders, this phone must be a landline phone at the installation site. For shared line DSL orders, this will be the DSL line
Daytime phone
Evening/cell phone
When is a good time to call?
(please note your time zone)
Building type
Telephone box location
Your email address
Preferred contact method
Additional info

indicates required field