Real Name......... Address 1......... Address 2......... City.............. State............. ZIP............... Home Phone........ Work Phone........ Fax Number........ E-mail address(if applicable)... Account Type.................... Personal PPP Dial-up Account($21.99/mo. unlimited usage) Personal PPP Account/with Personal Web Space($31.99/mo.) Personal ISDN Account(ISDN-P40, from $29.00/mo.) Personal ISDN Account(ISDN-P100, from $49.00/mo.) Business ISDN Account(ISDN-B40, from $55.00/mo.) ISDN Account/Unlimited Access(128Kbps, $399.00/mo.) 144k/144k IDSL Service 192k/192k SDSL Service 384k/384k SDSL Service 768k/768k SDSL Service 1.1M/1.1M SDSL Service 384k/1.5M ADSL Service Business Account(Business 101, $55.00/mo.) 128Kbps T1 Service($399.00/mo.) 1544Kbps T1 Service($899.00/mo.) Co-Location Service($499.00/mo.) Note: The above price is based on users who pay by creditcard. Additional $2.00 charge will apply for users who pay by check. Preferred Login Name............ (limit 8 characters) Billing Method: Check. Credit Card(VISA/Master). Primary Local OS Platform....... Microsoft Windows 95 MAC/Power MAC Microsoft Windows NT
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