Your contact information:

Technical contact if other than yourself

Your T1 should be  unchannelized or channelized

Your  T1 should be frame relay or standard  

What portion of a T1 circuit do you need? 
      Full T1 (1.54 Mbps)     
   fractional T1 (768 kbps)   
   fractional T1 (512 kbps)     
   fractional T1 (256 kbps)   
   fractional T1 (128 kpbs)   

This T1 circuit will be used for?
  data only         
  data and voice
  voice only         

Contract length (generally the long the contract the better the rate)
3 Years 
2 Year  
1 Year  

How soon do you need this T1 circuit?

This T1 is:  a new circuit replacing existing service  
If this T1 is replacing existing service, who currently provides service?

What is the address where the T1 circuit is to be installed?

If this is a point to point installation what is the address for the remote connection?

Other requirements , comments or useful information about your long distance T1 circuit