Smart Phones
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Full Name
Phone Number*
Preferred Date*
Preferred Time Slot* —Please choose an option—8:00 am-10:00 am10:00 am-12:00 pm12:00 pm-2:00 pm2:00 pm-4:00 pm4:00 pm-6:00 pm6:00 pm-8:00 pm8:00 pm-10:00 pm
Postal Code*
Current Service Provider* —Please choose an option—BellFidoRogersVirginOthers
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