Follow these easy steps!

Step 1. Complete this form and submit it to the Residential Sales Department.

  1. Your Name(*)
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  2. Address(*)
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  3. City/State/Zip(*)
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  4. Email Address(*)
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  5. Prefered Phone Number(*)
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  6. Name of Person being Referred(*)
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  7. Address(*)
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  8. City/State/Zip(*)
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  9. Email Address(*)
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  10. Prefered Phone Number(*)
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  11. Additional Comments
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  12. antispam
    antispam
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Step 2. A Sales Representative will contact the person you referred.

Step 3. The referral person signs up with Veracity Networks residential services.

Step 4. We process the order with this form to confirm account activation.