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Interest Form

Express Interest
Which type of service are you interested in?

Thank you for your interest in Platinum Connect. Please complete the form below to sign up for fiber optics.

Help bring Platinum Connect's reliable FIBER connection and services to your business by completing this form. After reviewing your submission one of our Commercial Account Reps will reach out to plan your installation.

Customer Information

Primary Phone Type *
Secondary Phone Type

Service Address

Mailing Address

Is your Mailing Address different than your Service Address? *

Home Ownership Information

Do you own or rent the location you would like a fiber connection? *

Interested Services

Which Platinum Connect services are you interested in? *
Which Platinum Connect services are you interested in? *

Who can we thank for referring you to us?

Platinum Connect yard signs are a great way to increase interest in your area, would you like to have a sign placed in your yard?