Enter Hotspot Information (fields marked with * are required)

Your Information
First Name*
Last Name*
Phone Number
[ xxx-yyy-zzzz ]*
Your email*
Your Role*

Hotspot Location
Hotspot Business Name*
Business Location Type 
Street Address*
State or Province*
Zip / Postal Code*
Business Phone [ xxx-yyy-zzzz ]* --
Hours of Operation      to     
Business website 

Wireless Internet Access Information
Hotspot Type*
Internet Connection Type
Check here if hotspot
internet access is free
SSID (network name)*
Customer Support phone
(or hotspot phone)
[ xxx-yyy-zzzz ]*
Customer Support Email
(or hotspot contact email)*