AT&T Only 1 Sales Rep Info2 Customer information3 AT&T High Speed Internet 4 AT&T Voice Product5 Additional Promotions6 Notes7 Order Summary Sales Rep* First Last Sales Rep Phone*Sales Rep Email:* Sales ManagerEmail:* Business Name*Customer Name* First Last Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Phone*Cell PhoneEmail* Tax ID*If Customer has no TAX ID input "Sole Proprietorship"File*-Upload Letter of Agency -Upload Order Form -Upload Phone Bill & Internet Bill Drop files here or AT&T U-Verse High Speed Internet U-Verse DSL U-Verse*HCMNon-HCMHCM*New U-verse < 6M - $30New U-verse < 12M - $33New U-verse < 18M - $30New U-verse < 25M - $30New U-verse < 25M - 50M - $43New U-verse 75M - 100M - $43Billing Account # BAN*Non-HCM*New U-verse < 6M - $43New U-verse < 12M - $43New U-verse < 18M - $43New U-verse < 25M - $43New U-verse < 25M - 50M - $73New U-verse 73M - 100M - $108Billing Account # BAN*DSL*NoneNew - DSL 6M - $45Existing - DSL 6 - $45New DSL To Existing - $45AT&T Phone Number*3 Digit Code*Total $0.00 Lines POTS Lines VOIP # of POTS Lines*012345678910# of VOIP Lines*0123456Line 1 - POTS*New Line - $40Porting - $40AT&T Phone Number 1*3 Digit Code*Porting Phone 1*AT&T Account Phone Number*3 Digit Code*Porting Phone 1*Line 2 - POTS*New Line - $40Porting - $40AT&T Phone Number 2*3 Digit Code*Porting Phone Number 2*AT&T Account Phone Number*3 Digit Code*Porting Phone Number 2*Line 3 - POTS*New Line - $40Porting - $40AT&T Phone Number 3*3 Digit Code*Porting Phone Number 3*AT&T Account Phone Number*3 Digit Code*Porting Phone Number 3*Line 4 - POTS*New Line - $40Porting - $40AT&T Phone Number 4*3 Digit Code*Porting Phone Number 4*AT&T Account Phone Number*3 Digit Code*Porting Phone Number 4*Line 5 - POTS*New Line - $40Porting - $40AT&T Phone Number 5*3 Digit Code*Porting Phone Number 5*AT&T Account Phone Number*3 Digit Code*Porting Phone Number 5*Line 6 - POTS*New Line - $40Porting - $40AT&T Phone Number 6*3 Digit Code*Porting Phone Number 6*AT&T Account Phone Number*3 Digit Code*Porting Phone Number 6*Line 7 - POTS*New Line - $40Porting - $40Phone Number 7*3 Digit Code*Porting Phone Number 7*AT&T Account Phone Number*3 Digit Code*Porting Phone Number 7*Line 8 - POTS*New Line - $40Porting - $40AT&T Phone Number 8*3 Digit Code*Porting Phone Number 8*AT&T Account Phone Number*3 Digit Code*Porting Phone Number 8*Line 9 - POTS*New Line - $40Porting - $40AT&T Phone Number 9*3 Digit Code*Porting Phone Number 9*AT&T Account Phone Number*3 Digit Code*Porting Phone Number 9*Line 10 - POTS*New Line - $40Porting - $40Phone Number 10*3 Digit Code*Porting Phone Number 10*AT&T Account Phone Number*3 Digit Code*Porting Phone Number 10*Line 1- VOIP*New Line - $30Porting - $30Ban # 1*Porting Phone Number 1*Line 2- VOIP*New Line - $30Porting - $30Ban # 2*Porting Phone Number 2*Line 3- VOIP*New Line - $30Porting - $30Ban # 3*Porting Phone Number 3*Line 4- VOIP*New Line - $30Porting - $30Ban # 4*Porting Phone Number 4*Line 5- VOIP*New Line - $30Porting - $30Ban # 5*Porting Phone Number 5*Line 6- VOIP*New Line - $30Porting - $30Ban # 6*Porting Phone Number 6*Total $0.00 Additional Promotions Free 32in TV Gift Cards ($100 New U-verse customers only) channelNotes {all_fields} Δ