Individual Account   Business Account

Surname:

First Name:

Name of Business, if applicable:

Telephone:

Fax:

Address:

Type Of Computer PC MAC OTHER

Operating System WINDOWS 95 WINDOWS 98 WINDOWS 3.1 WINDOWS NT OTHER

CD ROM Present:      YesNo

Type of Modem INTERNAL EXTERNAL

Speed of Modem 14.4 Kbps 28.8Kbps 33.6 Kbps 56 Kbps Not Known/Other

Username requested

(no more than eight (8) characters

Password requested

(no more thatn eight (8) characters

note: Your username will be your email name e.x smith@networksgy,com, smith will be your username and e-mail.

Are you a subscriber to any other ISP

Yes

No