SIGNUP ONLINE

Thanks for your interest in Complete Internet Access. Please fill out the following form to signup online for an internet access account. Your account will be activated in 24 - 48 hours.

Name:

Email Address (if you have one):

Street Address:

City:		State:		Zip Code:

Home Phone Number:

Please select which access plan you would prefer:

$20 signup fee applicable for all plans:

Starter Plan (Monthly $14.95, unlimited hours) Advanced Plan (Monthly $18.95, 2 logins, 5 e-mail boxes, unlimited hours)

Credit Card:
MasterCard Visa Amex Discover
Card Number:

Expiration Date (MMYY):

Make sure you enter the login name & password in all lower case and it must be between 4 to 8 characters (numbers or letters). Please do not choose common names as most of them are already taken on our system.

Prefered Login Name - less than 8 letters
Preferred Password
Mother's Maiden Name

Do you need software? (Current we ship Netscape Communicator 4.04)
No I Don't Need Software Windows 95 (cd-rom) Mac OS (cd-rom) Windows 3.1 (cd-rom)

Please choose a number that is local to you from our phone list and enter the number here: