Application Form – NetFlash

Internet Application Form

* Name:

First

Last

* Phone Number:

Email:

For locations without address please leave address fields below empty and enter the GPS coordinates only.

Address:

Street Address

Address Line 2

City

State / Region / Province

ZIP / Postal Code

Country

Click to use Google Maps tool.
Find your location and click on it. Look for a pop up at the bottom with your location coordinates.

* GPS Coordinates: (Example: 35.168871, 33.359188)

* Internet Package:

5Mbps

20Mbps

40Mbps

(Optional) Referral number:

Enter your referral code if you have one.

*** Note that by indicating your interest above, you may be contacted directly by NetFlash authorized partners with additional questions and installation information. ***

* Please check the box.