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Dial-Up Service Sign-Up Form   

 

Please carefully read and fill this form out in its entirety. If you do not receive your materials within one week's time, please call to confirm your request was received.

SAA bright.net requires a computer with a Pentium (PC) or Motorola 68030 (Mac), 16 Mb of RAM (32 recommended), and at least a 33.6 modem. We cannot take responsibility for erroneous or otherwise inaccurate information you provide on this form concerning your computer. If you are unsure of the specifications for your computer, please consult a local computer retailer before applying for an account.

Account Info
Name:
Last 4 of SSN (for security):
Address:
City: , OH
ZIP Code:
Username:
Alternate Username:
County of Residence:
Phone Number:
Modem Speed:

Operating System: Win95 Win98 Mac WinNT  WinME Win2K WinXP

I Want the Following Type of Service... Pick Just One

Unmetered Service  - Williams County @ $21.95

Unmetered Service @ $21.95  - Defiance/Paulding County

15hr per month, $2.25 per hour overtime.

I will be using the service for

Additional Suggestions/Requests
Such as billing to a credit card or direct debit bank account

 
 

This site is Copyright 2002 by SAA bright.net, Inc. * Travis B. Sheaffer, CCNA, RHCE Webmaster