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1 forms found in the DOM

POST /fsg?pageId=3bfeb1bc-eb23-43d9-bb45-29ae73a5102b&variant=a

<form action="/fsg?pageId=3bfeb1bc-eb23-43d9-bb45-29ae73a5102b&amp;variant=a" method="POST"><input type="hidden" name="pageId" value="3bfeb1bc-eb23-43d9-bb45-29ae73a5102b"><input type="hidden" name="pageVariant" value="a">
  <div class="fields">
    <div class="lp-pom-form-field single-line-text" id="container_name"><label class="main lp-form-label" for="name" id="label_name" style="height: auto;"><span class="label-style">Name&nbsp;*</span></label><input id="name" name="name" type="text"
        class="ub-input-item single text form_elem_name" required=""></div>
    <div class="lp-pom-form-field email" id="container_email"><label class="main lp-form-label" for="email" id="label_email" style="height: auto;"><span class="label-style">Email&nbsp;*</span></label><input id="email" name="email" type="email"
        class="ub-input-item single text form_elem_email" required="" pattern="^[a-zA-Z0-9._%+\-]+@[a-zA-Z0-9_\-]+[.]+[a-zA-Z0-9\-.]{2,61}$"></div>
    <div class="lp-pom-form-field single-line-text" id="container_zip_code"><label class="main lp-form-label" for="zip_code" id="label_zip_code" style="height: auto;"><span class="label-style">Zip Code&nbsp;*</span></label><input id="zip_code"
        name="zip_code" type="text" class="ub-input-item single text form_elem_zip_code" required=""></div>
    <div class="lp-pom-form-field drop-down" id="container_current_internet_provider"><label class="main lp-form-label" for="current_internet_provider" id="label_current_internet_provider" style="height: auto;"><span class="label-style">Current
          internet provider</span></label><select id="current_internet_provider" name="current_internet_provider" class="ub-input-item single form_elem_current_internet_provider">
        <option value="Select one">Select one</option>
        <option value="AT&amp;T (non-fiber)">AT&amp;T (non-fiber)</option>
        <option value="AT&amp;T (fiber)">AT&amp;T (fiber)</option>
        <option value="Xfinity/Comcast">Xfinity/Comcast</option>
        <option value="Fidium/Consolidated">Fidium/Consolidated</option>
        <option value="Optimum/Suddenlink">Optimum/Suddenlink</option>
        <option value="Frontier">Frontier</option>
        <option value="MetroNet/Vexus">MetroNet/Vexus</option>
        <option value="Other">Other</option>
      </select></div>
    <div class="lp-pom-form-field drop-down" id="container_monthly_internet_bill"><label class="main lp-form-label" for="monthly_internet_bill" id="label_monthly_internet_bill" style="height: auto;"><span class="label-style">Monthly internet
          bill</span></label><select id="monthly_internet_bill" name="monthly_internet_bill" class="ub-input-item single form_elem_monthly_internet_bill">
        <option value="Select one">Select one</option>
        <option value="Under $50">Under $50</option>
        <option value="$50-60">$50-60</option>
        <option value="$60-70">$60-70</option>
        <option value="$80-90">$80-90</option>
        <option value="$90-110">$90-110</option>
        <option value="$110+">$110+</option>
      </select></div>
  </div><button class="lp-element lp-pom-button" id="lp-pom-button-13" type="submit"><span class="label"><strong>SUBMIT</strong></span></button>
</form>

Text Content

Ready for lightning fast fiber? Something big and bright is coming to Texas!

Name *
Email *
Zip Code *
Current internet providerSelect oneAT&T (non-fiber)AT&T
(fiber)Xfinity/ComcastFidium/ConsolidatedOptimum/SuddenlinkFrontierMetroNet/VexusOther
Monthly internet billSelect oneUnder $50$50-60$60-70$80-90$90-110$110+
SUBMIT

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