2. Business Name
4. Address
6. City
7. State
8. Zip Code
10. Email Address
11. Phone Number
13. May we include you on updates and engagement opportunities from the Rural Broadband Task Force?

    1. Yes
    2. No
14. Do you currently provide services within Rowan County?

    1. Yes
    2. No
16. Which Internet Services do you currently or plan to provide?

    Check all that apply

    1. Digital Subscriber Line (DSL)
    2. Cable Modem (DOCSIS)
    3. Fiber to the Home (FTTH)
    4. Fixed Wireless (WISP)

    1. Cellular Data Plan
    2. Satellite Internet Service
    3. Infrastructure Services for Internet Service Providers
    4. Consulting Services
18. May we list you on our broadband local service provider page?

    1. Yes
    2. No
19. Please provide a URL that would link directly to your service offering:
21. Additional Comments:
Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit Submit and Print

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