IMPORTANT:  Each asterisked field (*) must be not be left blank.  If a field marked with an asterisk is not applicable for your situation, enter “X” or “none”.  The form will not be submitted if an asterisked field is left blank.

 

 

We will contact you via email within 3-5 business days after receiving your completed form. If you don’t receive a confirmation email within that time period, please email zlcw@mncable.net or call 218-386-1733, ext. 1.