DSL Pre-Qualification Request

Residential ADSL service is currently available in Rock Island, Moline, East Moline, Milan, Colona, Green Rock, Silvis, Peoria, Galena, Davenport, Bettendorf and Dubuque. Even if you didn't qualify for DSL before, or your telephone company has told you they can't get DSL to you, the expanded service area of our sister company AscendTel may be the answer for high-speed Internet Access. Fill out the form below to find out if you qualify for ADSL in these areas..

First Name, Middle Initial, Last Name:

This must be a valid name

Company Name (if applicable):

Physical Address:

This must be a valid address

City, State and Zip:

This must be a valid city
	This must be a valid zip code

Daytime Phone Number:

This must be a valid phone number

555-555-1234

Fax Number:

Email Address:

This must be a valid email address

Questions/Comments/Additional Contact Information:
(If you have a local phone number at the above address, but this differs from your contact number, please provide your local number for ease of pre-qualification)

denotes required fields

By submitting this Pre-Qual request you are authorizing Ascendtel, LLC to access your telephone account information with your Telephone Company for purposes of address validation only.

Responses can take up to two (2) business days to complete. If you have any questions, please feel free to call our office at 309-736-8000.