One time $10 setup fee per account
Please fill out the following form:
Name of Company:
Job Title:
Address: (Include City, State, and Zip Code)
Phone # (Include Area Code):
Fax #:
Billing Information
Billing Address: (if different from above) (Include City, State, and Zip Code) the same
Authentication Information
Username (max 8 characters): 1st Choice:
2nd Choice:
Starting Password -> (Must be a minimum of 6 characters with at least 1 number, which may be changed later):
Any additional comments for us?:
What operating system do you run? Windows XP Windows 2000 NT 4.0 NT 3.51 Windows ME Windows 98 Windows 95 Windows 3.x MacOS X MacOS 9.x MacOS 8.x MacOS 7.5.x MacOS 7.1.x UNIX (Linux, FreeBSD, SunOS) BeOS Palm Pilot Windows CE (any version) Psion Netware 6.x Netware 5.x Netware 4.x Netware 3.x Don't know or none or the above What speed modem do you have? 14.4K to 33.6K 56K ISDN ($25/month) Dont't know or none of the above How much RAM do you have? 32Mb 64Mb 128Mb 256Mb 512Mb 1Gb or more Don't know or none of the above How did you find out about us? (give name if possible):
Domain Name (will be registered after your first paid invoice):
If you have any questions, call Rahsaan Townsell at 215-227-5462.
If you are finished, please click on the Submit button. If you need to start over from the beginning, please click on the Start Over button.