User Sign Up Form

This form must be filled out completely!

User and Billing Information:

Name
Address
City
State Zip
Phone Fax

Your E-Mail Address Choices:

1^stChoice: @FreeBucks.com
2^ndChoice: @FreeBucks.com
3^rdChoice: @FreeBucks.com

Would you like additional E-Mail boxes? If so, list them below:

(Each additional box is $2/month- remember to include this times the service period 3 or 6 months)

Do you currently have an E-Mail address? Please list it below:

Payment Method

Direct Billing in advance of service is the only option available at this time
Direct Bill

Dial-up service agreement

I DO NOT Agree to the Basic Terms
I DO Agree to the Basic Terms

Can we help you with any of the following?

T1 fractional T1 Access for my business?
Other Leased Line Access for my business?
ISDN services?
Web Hosting for my business?
Long Distance at 10.9 cents/minute for my home or business?

PLEASE SELECT YOUR RATE PLAN FROM THE CHOICES BELOW

First 1 month with Setup TOTAL: $19.95
64k ISDN dialup - First 3 months and setup is $73.50, and $24.50 a month thereafter.
128k ISDN dialup - First 3 months and setup is $105.00, and $35 a month thereafter.
Domain and Web Site Hosting - First 3 months and setup is $60, $20.00 a month thereafter.

This account is provided under the terms and conditions of our service agreement.

I have read and agree to those terms and conditions.

Please READ the Service Contract.