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REFERRAL CARD

Using your web browser's print function print this form and fill the first part out completely. Then give it to a friend or family member who is interested in internet access. When they send in the form with payment in full for internet access, you will receive a $10.00 Check.


                                  Fill in your current customer information.

Last Name_______________________     First Name_______________________

Company Name____________________   Username_______________________

Mailing Address____________________________________________________

City__________________  State___________________  Zip Code___________

(Area Code)________  Phone Number__________________________________


       --------------------------------------------------------------------------------------------------------
                                     New referred customer application

Requested Username_______________________  Password_______________

Last Name____________________  First Name__________________  MI_____

Company Name____________________________________________________

Mailing Address____________________________________________________

City__________________  State___________________  Zip Code___________

(Area Code)________  Phone Number__________________________________

Amount Enclosed:
  |__| $24.95 Monthly   |__| $69.95 Quarterly |__| $124.95 Semi-Annually  |__| $214.95 Annually

  |__| Macintosh   |__| Windows 3.1   |__| Windows 95   |__| Other_________

For Webhosting referrals please call.

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