Dial Up Numbers:        Tech Support
Cutler, Frankfort, Michigantown: 258-5600          258-HELP   or   877-994-8355
Burlington, Rossville: 258-5600      Mon - Fri: 8:00 AM - 5:00 PM

Name:________________________________________________________________________
Address:______________________________________________________________________
City:___________________________________ State:________ Zip:______________________
Telephone Number:_____________________________________________________________
Mother’s Maiden Name:__________________________________________________________

Choose an EMAIL name up to 8 characters, all lower case: ___ ___ ___ ___ ___ ___ ___ ___

Choose a PASSWORD up to 8 characters, all lower case: ___ ___ ___ ___ ___ ___ ___ ___

DSL
____ Bronze         $29.95/month 1.5 Mbps down / 256 Kbps up 
____ Silver           $39.95/month 3.0 Mbps down / 384 Kbps up
____ Gold            $49.95/month  5.0 Mbps down / 768 Kbps up
____ Platinum       $59.95/month 8.0 Mbps down / 768 Kbps up
____ Diamond      $79.95/month 10.0 Mbps down / 768 Kbps up

Wireless
____ Bronze         $29.95/month 832 Kbps down / 256 Kbps up 
____ Silver            $39.95/month 1.5 Mbps down / 384 Kbps up
____ Gold             $49.95/month  3.0 Mbps down / 768 Kbps up
____ Platinum        $59.95/month 5.0 Mbps down / 768 Kbps up

* All connection speeds listed are maximum connection speeds.    Network conditions may affect connection speeds. 

Dial Up 
____ Starter Package        $14.95/month                                   ____ Unlimited Package      $18.95/month 
____ 1 Year Package $160.00  non-refundable after 30 days 

Bill Me Monthly ____________ 

Charge my Credit/Debit Card Monthly _____________  ( charges to card will be made on the 17th of each month)

VISA MC DISCOVER Account# ________________________________________________Exp. Date______

I hereby certify that the above information is correct, that I have read the Acceptable Use Policy, and that I agree to use the Internet in a legal, ethical, and positive manner.

SIGNATURE: _____________________________________________________Date: ___________________

Monthly Internet usage is calculated beginning on the 1st of each month at 1:00 a.m.  Unlimited access is defined as 744 hours, which is equal to 24 hours, 31 days a month.  There will be a $35.00 trip charge for any in-home Internet setup during normal business hours and $45.00 charge outside of normal business hours. Normal business hours are defined as Mon-Fri: 8:00 AM - 5:00 PM.