New Service - Customer Information



		Step 1: Customer Information



		Step 2: Choose Services



		Step 3: Configure Services



		Step 4: Review and Submit Order

FREE CALLS TO HOME And free One Number Service when you have a Qwest Wireless® plan and home phone service.

Customer Information

Qwest, your one-stop shop, can help you set up your Qwest services plus your Electric, Gas, Water and more in our 14-state region. Enter your name and new service address and we’ll determine the products and services available to you. You can choose from featured offers including:

Broadband Internet
Digital Voice: Local and Long Distance
Digital TV
Wireless

Name

* Required Fields

* First Name	MI	* Last Name

Co-applicant Name
(A second person authorized to make purchases on or changes to this account.)

New Service Address

	Need Assistance? Take a look at some tips on entering your information.

Enter the address where you need service. This should be a physical street address – not a P.O. Box. Leave optional address fields (e.g., suffix field) blank, if they don't apply. Be careful to confirm the street address in the below verification window matches your address. You may change the street address fields until the address in the verification window is correct.

*House Number	Direction	*Street Name	Street Type	Suffix

(e.g., 1250-1/2)	(e.g., North)	(e.g., Broadway, Main, Elm)	(e.g., Street, Road, Drive)	(e.g., Northwest)

Unit Type

Unit Number
(e.g., 3A or A3)

* City

* State

* ZIP Code (e.g., 80220)
Find a ZIP Code

Street Address




	Is there current service at this address that should remain connected, such as a second phone line?			Yes No


	Do you currently have working local phone service (wireless not included) with Qwest at your new service address or any other location?			Yes No


	Have you had previous phone service with Qwest?			Yes No


	Will this also be your new billing address?			Yes No


	Sign up for Qwest Paperless Billing? Why Paperless Billing? Upon completion of this order get signed up for $10,000 Sweepstakes.			Yes No

Billing Address Verification

	Need Assistance? Take a look at some tips on entering your information.

Enter the billing address for your new service.

Street Address

*House Number	Direction	*Street Name	Street Type	Suffix

Ex: 3456		Ex: Main, Elm, Broadway

Unit Type

Unit Number (e.g., 3A or A3)

* City

* State

* ZIP Code (e.g., 80220)
Find a ZIP Code