PLEASE NOTE: This form is for new customers only! Do not fill out if you currently have an account or are experiencing technical issues. Please call 1-888-671-5465 for YourLink Customer Support.


1. First Name
2. Last Name
3. Email Address
*Required
NOTE: If you do not have access to email, please contact the Sales @ 1-866-650-5465.

4. Phone (Home)
5. Phone (Daytime)
6. Phone (Cellular)
7. Mailing Address
8. Town/City
9. Province
10. Postal Code
11.
Land Location
  R.M. #
12. Choose Your Package [Residential Packages] | [Business Packages]
Lite - $30.99/month
Residential - $47.99/month
Residential Advantage - $55.99/month
Small Office/Home Office - $65.99/month
Small Office Advantage - $79.99/month
Business - Price quote available upon request

13. Equipment Options
Purchase - $249.99
Rent - $15.99/month* [See below for details]

Click here for complete promotion details!
14. LinkShield [Learn more...]
Annually - $40.00
Monthly - $3.99
No
Unsure

15. Driving Directions or Street Address:

16. How did you hear about us:

*With YourLink's equipment rental option, a security deposit is required from the customer at the time of installation. This can either be a major Credit Card number, or a $150 cheque made payable to YourLink Inc. Installation and mileage charges also apply, with details provided when your installation is scheduled.