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.

First Name		Last Name

Company Name		Email Address (if you have one)

Street Address		Apartment

City		State		Zip Code

Home Number

Work Number

FAX Number

What type of system are you running?

PC Running Windows 95
PC Running Windows 3.x
Macintosh Running MacOS
Any UNIX-based system
Other System

If you have either a Macintosh or a PC running Windows, would you like FREE copy of Netscape Navigator 2.0?

Please select which access plan you would prefer:

$20 signup fee applicable for all plans:

Starter Plan [$14.95/mo, unlimited access]
Advanced User Plan [$18.95/mo unlimited hours, NO Additional hourly fees]

Prefered Login Name - less than 8 letters
Preferred Password
Enter Password Again to Verify

Please select a payment method:

Credit Card AMEXDiscoverMasterCardVisa

Credit Card Number

Expiration Date

Name of the Cardholder
or ...

Check auto deposit

Bank Name

Routing Number

Check Number

spy@thecia.net