Evergreen Telecom Services LLC Online Quote Request
  How Can We Help? (check all that apply)
  By completing this form in its entirety, one of our certified and trained Network Consultants will call you back with pricing information and a solution. Please expect a response within 24 hours.
   I am interested in establishing new service.
   I need pricing.
What is your projected date for installation?
  Please let us know what products and services you need. (check all that apply)
Voice Services
   Business Phone Lines
   Business Trunk Lines
   VoIP
   Voice T1
   Long Distance T1
Cellular:
Data Services
   ISDN
   T1
   DSL
   Frame Relay
   Leased Lines (Private Line)
   LAN-LAN Interconnection
   Wide Area Networking
   ATM Networking
Internet Services
   Web Hosting
   Co-Location
   Dedicated Server
   Web Design
   E-Commerce
  Please provide some background about your company.
Phone System
What type of phone system do you currently have?
How many phones do you have/need?(including fax, modem lines)
How many phones lines do you have/need?
Hunting?
If so, on How many lines?
Security / Alarm Lines?
Toll free number(s)
Audio Conferencing Service?
Voice Mail Service?
How many additional phones lines would you like to add?
What is your average monthly local phone cost?
What is your average monthly long distancee phone cost?
Business Size and Industry
How many locations does your business have?
How many employees?
Industry Segment:
Where are your customers located? (check all that apply)
   Local
   Regional
   National
   International
How does your business use the Internet? (check all that apply)
Type of internet service currently used:
Current internet speed:
   E-Mail
If so, how many accounts?
If not, would you like to have email service?
   VPN
If not, are you interested in learning more about VPN services?
   Research
   Intranet
   Website
If so, what is the monthly hosting charge?
If not, would you like to have a Web site?
   Extranet
   E-Commerce
   Remote Access to LAN
Other (please explain)
   Data Backup
If so, how is your data backed up?
If not, would you like to have tape backups?
Your computing environment
How many PC Workstations does your company have?
Does your company have a LAN?
If yes, please describe briefly:
Does your company have a WAN?
If yes, please describe briefly:
  Company and Contact Information
Company Information
Company Name:
Address 1:
Address 2:
City:
State:
Zip Code:
Contact Information
Main Business Telephone #
Contact Person:
   Contact person is a decision maker.
Contact Telephone #
Contact Email Address:
Preferred method of response:
Your Company Website:
  Authorization
  If your request requires that we access your account information or make an order on your behalf, we will need your authorization to do so. Please check both checkboxes below to indicate your authorization for Evergreen Telecom Services LLC to access your account information or to place orders on your behalf.
 
 I authorize (the Carrier entered below in textbox) to release account information to Evergreen Telecom Services LLC relative to the account described above. This information may include ordering usage and billing data, class and type of service, number and type of lines and other account information including voice services, data services and long distance services .
Carrier:
 
 I authorize Evergreen Telecom Services LLC to place orders for service on my behalf, however, this does not preclude my ability to act in our own behalf. This authorization for release of account information and order placement remains in effect until cancellation notification is provided to BellSouth in writing.

Please Enter Security Code