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  Wireless Application Form

This is a secure form

* = Required Fields

STEP 1 OF 3 		USER INFORMATION
*  Full Name (First Last):
*  Business Name  
(if business account) :
*  Street Address :
*  City :
City/Township: (Former Name)
*  Province :
*  Postal Code :
*  Telephone Number :
*  Work Telephone Number :
*  Fax Number :
*  E-mail :
Promo Code ID:
*  How did you hear about Storm?
 
STEP 2 OF 3 ACCOUNT INFORMATION
*  Do you already have an  
account with Storm : 		Yes No
*  UserID  
(8 characters max) :
*  Password  
(between 3 and 8 characters) :
Note: The UserID will form the first part of your email address before the @storm.ca (example: UserID "Smith" means email address will be Smith@storm.ca).
 
STEP 3 OF 3 PAYMENT INFORMATION
Note: Your payment information will be collected after a “Site Survey” is conducted at your location, helping us understand if the Storm HighSpeed | Wireless service is available to your location. If you can provide some additional comments below referring to line-of-sight with one of our existing towers, or information on close neighbors who use our service, that would be appreciated and may speed up your application.
*  Please select account type :
 
STEP 4 OF 4 EMAIL CONTACT
Storm will occasionally contact you with notices of ongoing maintenance on your connection, along with emailed invoices for your account. Privacy Policy
*  Primary Contact Email:
I wish to be contacted at my NEW storm.ca email address specified in the account information section above.
I already have an existing email address, please send all Storm correspondance to that address.
My existing email is:

Additional comments/questions :



NOTE: By submitting this application, you agree to these Terms and Conditions & Service Level Agreement

If you have any problems with this form please email or contact us at 613-567-6585. Thank you.