Service Lead Form Please ask the potential customer the following questions and then fill out some basic contact information for them so that one of our sales representatives may contact them. Web Site What Services are you Interested in? * Internet Phone Video Check all that apply. Who is your current Internet provider? Suddenlink AT&T Uverse AT&T Fiber Charter Windstream Other Who is your current TV provider? Suddenlink AT&T Uverse AT&T Fiber Charter Streaming Provider (Amazon Prime, Netflix, etc.) Other Check all that apply. First Name * Last Name * Phone Number * Email Address * Street Address * City, State * Abernathy, TX Abilene, TX Amarillo, TX Amite, LA Brownfield, TX Burkburnett, TX Colorado City, TX Franklinton, LA Hale Center, TX Hammond, LA Husser, LA Independence, LA Iowa Park, TX Lamesa, TX Levelland, TX Littlefield, TX Lubbock, TX Meadow, TX Montpelier, LA New Deal, TX Olton, TX Pine Grove, LA Plainview, TX Ponchatoula, LA Ropesville, TX Slaton, TX Smyer, TX Whitharral, TX Wilson, TX Wolfforth, TX Zip Code Contractor First & Last Name * Please type your full name here. Tech ID # * Please type your tech # here. Contractor Email Address * Please enter your email address here.