This form will help us determine your Internet access needs. Just fill in your contact information and the fields or choices that apply below.

We'll get back to you promptly with an assessment, including a cost estimate.

You may want to review our brief explanation of the different high bandwith services we provide.

Thank you for your interest in Atlantic Internet!

Contact Name:
Email address:
Company Name:
City/State:
Web Site URL:
Do you want us to contact you by phone or email?:
email   phone
Phone:
Best Time to Call:
Are you a member of exit109?
yes   no
Are you a school or educational institution?
yes   no


Provide us with answers to the best of your ability.
(check all that apply)

What type of access are you interested in? ISDN   T1

What is your bandwidth requirement?

Unsure
ISDN
    64 Kbps
    128 Kpbs

    ISDN Type:
    Dedicated
    Dial-On-Demand
T-1
    Full T-1 (1.544 Mbps)
    Fractional T-1
        256 Kbps
        512 Kbps
        768 Kbps

Does your choice represent actual/sustained bandwidth or bandwidth during peak usage?

Actual   Peak
How many simultaneous users (on your local area network)?
How many computers on your network?
How many hours per day do you plan on using the internet?
Will your (line) location be local to either Red Bank or Toms River exchanges?

(click here to find out)

yes   no
How many IP addresses do you need? (The IP block we assign will be based on demonstrated need.)
How many email boxes do you need?

We don't need any.
We will have our own mailserver.
If you own a web site or are planning a web site, where will the web site be located? On AIT's web server
On our own server
What equipment will you need us to provide?
Unsure
Router
CSU/DSU (for T-1 customers)
Network server
Other
(please explain)    
Are you interested in our network advisory services? yes   no
If so, please explain:

Please provide any additional comments, including other requirements, below: