Intake form

Name *

Email address *

What type of service are you interested in?

Please select at least one option.

Residential Internet

Business Internet

Customized Ethernet Solutions

Enhanced Security Measures

Smart City Connectivity

What is your primary use for the internet?

Please select at least one option.

Streaming

Gaming

Remote Work

Browsing

What is your current internet provider?

What is the estimated number of devices connected to your network?

What is your preferred method of contact?

What is your business type?

What is your location?

Which service or services are you interested in?

Please select at least one option.

High-Speed residential internet

Business internet services

Customized ethernet solutions

Additional questions or comments

Lighthouse Broadband