Basic Information:   Full Name: School Email Address:   Address: City: Home Number: Zip Code: Work Number: Have you purchased your own cable modem? Brand Name/Model: Cust Serial Number: MAC Address: If you currently have Cox Internet service, please enter your account number: * Located on your last bill.  Leave blank if not a current Cox Internet customer. Computer Information   Operating System: ---------------------------- Windows Vista Windows XP Other Ethernet NIC Installed? No Yes Please indicate the days you are available for installation:   Monday Tuesday Wednesday Thursday Friday Saturday Please indicate the best times for scheduling:   Anytime (8am-5pm) Morning (8am-12pm) Afternoon (1pm-5pm) Note:  Installation dates & times cannot be guaranteed, but all efforts will be made to accommodate them. Special Instructions: