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Please read the following dialup account agreement before filling out the membership form.
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Personal Information
Please read carefully and complete this form in its entirety.

Last Name: First Name:
Company: Fax:
Address: Tel:
City: Province:
Postal Code: E-mail:
Refered by: (user name)

System Information

User Name & Password
Please provide 2 user names in case the first choice is already taken.
(User Name: max. 8 characters, min. 3 / Password: min. 8 characters,
only ONE uppercase character, all the rest remain lowercase.
Do NOT use spaces or wildcard characters.)

Name1: Name2: Password:

Service Type
Standard 56K Account
15 hours per month (plus $1.00 per additional hour) $9.95
40 hours per month (plus $1.00 per additional hour) $12.95
60 hours per month (plus $1.00 per additional hour) $16.95
Unlimited Access $19.95

Taxes are applicable.


Payment Method:


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