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1. Account Type

Personal Home / Residential

Business Company / Commercial

2. Services Requested

Internet Mobility Security Smart TV

Internet Details

Internet Speed

Mobility Details

Number of Mobile Phones

BYOD (Bring Your Own Device)

New Devices

Device Protection

If you choose specific devices, list the device name(s) in the notes section below.

Security Details

Number of Cameras

Window Sensors

Window Break Sensors

Door Sensors

Motion Sensors

Carbon Sensors

Fire Sensors

Flood Sensors

Smart TV Details

Number of TVs

Must-Have TV Channels

List any channels that are important to you

3. Quote ID (if you have one)

Have a Quote ID Number?

If you previously received a quote from us, enter the Quote ID here so we can match your request.

4. Personal Account Information

Customer Name *

Authorized User Names

People allowed to make changes or inquire about the account

Physical Address *

Mailing Address

Shipping Address

Email Address *

Phone Number *

Six-Digit Security Code *

Used to verify your identity when contacting support

4. Business Account Information

Business Name *

Business Physical Address *

Mailing Address

Shipping Address

Principal Owner’s Name *

EIN / Tax ID *

Authorized User Names

Business Email Address *

Six-Digit Security PIN *

Business Phone Number *

Personal Phone Number

5. Additional Information (Optional)

Notes or Special Requests

By submitting this form you agree to be contacted by TechyOptions regarding your service request. Your information will be sent securely to our team.