PEI Broadband Residential Inquiry Form | eServices Prince Edward Island

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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)

Acceptance

Information contained in and collected in relation to this Agreement is subject to, and will be treated in accordance with, the Prince Edward Island Freedom of Information and Protection of Privacy Act. The amount of the Contribution may be disclosed at the discretion of Innovation PEI and in accordance with the Freedom of Information and Protection of Privacy Act R.S.P.E.I. 1988, Cap. F-15.01.

Personal information on this form is collected under Section 31(c) of the Freedom of Information and Protection of Privacy Act and is necessary to determine your suitability and/or eligibility for programs delivered by Innovation PEI. If you have any questions about this collection of personal information, you may contact Innovation PEI by telephone: 902-368-4669 or email: myinternet@gov.pe.ca.

I agree to the disclaimers and privacy statements.

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