office use only
Entered on Server: _____________ Reference #:__________________
Check #_____ Cash____ CC_____ Amount:_____________________
Dial Up Numbers: Tech Support
Choose an EMAIL name up to 8 characters, all lower case: ___ ___ ___ ___ ___ ___ ___ ___
Choose a PASSWORD up to 8 characters, all lower case: ___ ___ ___ ___ ___ ___ ___ ___
* All connection speeds listed are maximum connection speeds. Network conditions may affect connection speeds.
Bill Me Monthly ____________
Charge my Credit/Debit Card Monthly _____________ ( charges to card will be made on the 17th of each month)
VISA MC DISCOVER Account# ________________________________________________Exp. Date______
I hereby certify that the above information is correct, that I have read the Acceptable Use Policy, and that I agree to use the Internet in a legal, ethical, and positive manner.
SIGNATURE: _____________________________________________________Date: ___________________
Monthly Internet usage is calculated beginning on the 1st of each month
at 1:00 a.m. Unlimited access is defined as 744 hours, which is equal
to 24 hours, 31 days a month. There will be a $35.00 trip charge
for any in-home Internet setup during normal business hours and $45.00
charge outside of normal business hours. Normal business hours are defined
as Mon-Fri: 8:00 AM - 5:00 PM.