Nucleus Information Service Inc. - High Speed Internet

Nucleus DSL Referal Program:

If you have a friend or know a company that you feel would benefit from Nucleus DSL and would like to refer them to us, please fill out the form below. If they qualify and sign up with us and remain a client for at least 3 months, we will place a $25.00 credit on your account as a token of our appreciation.

By completing this form your friend is under no obligation to subscribe to the Nucleus DSL service. If service is not available, we will notify them when Nucleus DSL comes to their neighborhood.

Fields marked with an * are required

Your friends information

First Name:	*
Last Name:	*
Company name (if applicable):
Address:	*
City:	*
Home Phone: (include area code)	*
Work Phone: (include area code)	ext

Referred by the following Nucleus customer :

First Name:	*
Last Name:	*
City:	*
Home Phone: (include area code)	*
Email Address:	*