Application Request Form
Complete the form below to request an application to become a Jivas Internet Agent.
Contact Information
First Name
Last Name
Company
Phone (Day)
Phone (Night)
Best time to call
Email
Preferred Contact Method: Phone     Email
Type of Internet services interested in reselling :
(More than one service can be selected)
Residential DSL (ADSL) Business DSL (SDSL) T1 Dialup
Comments
We respect your privacy! Your information will only be used by us internally to process your application request and to contact you in regards to our agent program. This information will not be passed on to other third parties.  Please if you have questions.
ADSL: Asymmetric DSL. Download faster than upload. Shares both voice & Internet on the same line.
SDSL: Symmetrical DSL. Download and upload speeds are same. Uses a separate dedicated Internet line and does not share voice.
T1: A leased line connection capable of carrying data at a very high speed (1.544Mbps). T1 is the fastest telephone trunk line commonly used to connect networks to the Internet.
Dialup: Dialup services include 56K, Multilink, & ISDN