Impulse Internet Services - Serving the California Central Coast since 1995
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Wireless Services Pre-Qualification:

If you would like to know if your address will qualify for wireless service, please fill out this pre-qualification form and we will start the process immediately. You are not purchasing any service or committing to any future purchase by filling out this form, it is simply for qualification purposes. If you have any questions or concerns, please email wireless@impulse.net or contact us by other means.

 
Customer Information (items marked with * are required):
Contact Name: *
Service Type: Residential    Business
Company:
(ONLY if your company is to be billed.)
Address:
(Where antenna will be installed.)		 *
City: *
State:California ONLY!
Zip: *
If you are a residential customer, your HOME phone number is required.
Home Phone:(  )   -   x  *
If you are a business customer, your WORK phone number is required.
Work Phone:(  )   -   x  *
Mobile Phone:(  )   -   x 
Fax:(  )   -   x 
Are you an existing Impulse customer: Yes    No    Unknown
Username:
(Fill in if you are a current user.)
Email:
Reference:
(How did you hear about our wireless services.)
Comments:
 * required fields
Advanced system Information ( skip this section if you are unsure ):
Operating System:
Do you own a NIC:
(NIC = Network Interface Card / Ethernet Card)		 Yes    No
Submit information for Wireless access qualification:
 

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81 David Love Place, Suite 100 - Santa Barbara, CA 93117