INTERNET SIGN UP

Date:

Name:

Business:

Address:

City, State, Zip:

Phone No.:

Fax No.:

Password Requested:
(Lower case only - no more than 8 digits - either alpha or numeric or combination of both)

Your System Information:

Computer Type:

 IBM or compatible    Macintosh

Account Selection (Check One):

  Net Plus $19.95/Month-unlimited hours

  DSL  $49.90/Month - includes internet and DSL

Other Account Options:

E-Mail Alias ($5.00 one time fee):
(Click here for more information)

1st Choice:

2nd Choice:

  I am hereby applying for Internet dial-up or DSL access through SMTC.  I acknolwedge that I have read and fully agree to comply with the Terms and Conditions.
If I have applied fo DSL, I agree to:

a).  Comply with the “DSL Service Terms and Conditions”

b).  To commit to a fixed term of 12 months of DSL service, whereby the $95 installation fee is waived,

c).  If I disconnect DSL service before the fixed term has expired, a $95 cancellation fee will apply.