Membership Application
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Terms and Conditions
First Name
Middle Name
Last Name
Address
City
State
Zip
E-mail Address (optional)
Home Phone
Work Phone
Your Homepage
Credit Card #
Expiration Date
/
Card Type
Mastercard
Visa
Last 4 digits of your Social Security #
Your Operating System:
Win XP/Vista
Win ME/9
x
Win NT/2000
Linux
MAC
Web TV
I would like to sign up for
months.
Dialup membership cost $12 per month, or $11 per month if you sign up for 6 or more months at one time, plus a $10 sign-up fee. Partial months are pro-rated, however, at least one month must be paid for.
I have read and agree to the
terms and conditions
. I realize that my account may be terminated without notice for violation of any of the terms and conditions. I also agree that I am at least 18 years of age.
Please Click Here
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