Order High-Speed Internet

Account Information

Name (required)




Zip Code

Phone Number (that DSL will be installed on)

Contact Information

Daytime Phone Number

Your Email

High-Speed Internet Service Order Form

Select a Package

*Pricing does not include basic rate for residential or business telephone line. High-Speed Internet service requires an active telephone line and modem. Applicable taxes, Federal Universal Service Fund Charge and equipment charges apply. Additional terms and conditions apply.

Promotional Offer

If service is added during promotional period offering monthly discounts, a one-year contract is required. After the specified promotional period, regular monthly charges apply. An, early termination fee of $175.00 applies if service is terminated before the first anniversary date.


Would you like to rent or purchase your high-speed Internet modem?

Note: If you purchase your modem, it comes with a 1-year warranty.

Minimum System Requirements

Please be sure to review our minimum system requirements to be sure that your computer meets these requirements. Your computer is required to have an Ethernet Card.

User Information

If you would like an email address, please provide us with your 1st and 2nd choice for a username.

Username (first choice):

Username (second choice):

Username must be lower case, exceed 4 characters and may include letters and numbers (must start with a letter). For security reasons, a password will be assigned when your High-Speed Internet order is processed.


All devices sharing the same telephone line as your High-Speed Internet service must be connected to the line through a special filter. This may include: phones, fax machines, caller ID boxes, answering machines, satellite TV receivers, alarm systems, and any other analog device that might be using the same telephone line. Four filters are included with your High-Speed Internet service. Please indicate if you need more. If you have an alarm system installed at your home or business that shares the same telephone line that you are installing High-Speed Internet on, we recommend that you contact your alarm company regarding any special filters you may need for your alarm system.

A special wall mount filter is required if you have a wall mount telephone (commonly found in kitchens).

Do you require a wall mount filter?

Do you need more than the four filters that are included with your High-Speed Internet service? If so, please indicate the number and type of filter. If no, please leave blank.

Extra wall mount filters:

Extra in-line filters:

Will High-Speed Internet service be installed on a phone line that shares single wall jack ports with another phone line? (This is not very common, but does require a 2-line telephone filter).

Installation Options

Please select an installation option:

High-Speed Kit Delivery

Please note that if you have selected a Turn Key Installation the technician will bring the self installation kit.

Agree and Authorize

I acknowledge notice of, accept and agree to all of Green Mountain Access’ High-Speed Internet Services Terms and Conditions and its Acceptable Use Policy, copies of which are posted here (required). High-Speed Internet service is a best effort service and actual speeds may vary based upon equipment and line capabilities, distance from the central office, atmospheric conditions, the users computer system (processor speed and RAM), speed of the Internet, and other factors. Green Mountain Access High-Speed Internet service is not available in all areas.

Please retype your name to authorize this transaction: