PEI Broadband Fund for Residents Inquiry Form

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Personal information on this form is collected under Section 31(c) of the Freedom of Information and Protection of Privacy Act R.S.P.E.I. 1988, c f-15.01 as it relates directly to and is necessary for determining eligibility. If you have any questions about this collection of personal information, you may contact the Innovation PEI Office by telephone at 1-800-563-3734 or by email at innovation@gov.pe.ca.

Identification

Provide the civic address where Internet service will be improved.

First Name

Middle Initial

Last Name

Address 1

Address 2

City, Town, or Community

Province

Postal Code

For example C1B 0X1 or 12345

Country

Telephone Number

For example 902-555-5555

Email Address

Cell Phone Number

For example 902-555-5555

County

Inquiry

(1,000 character limit)

CAPTCHA

Math question 4 + 10 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.