Information Superhiway Internet Signup Sheet

Name

Address

City

State

Zip

Phone:

Payment Type:

Cash Check Credit Card

Credit Card Type:

Visa Master Card Discover

Please call 483-9245 to arrange payment

Username:

Password:

Email Account 1

Name:

Email Address:

@informationsuperhiway.net

Password:

Email Account 2

Name:

Email Address:

@informationsuperhiway.net

Password:

Email Account 3

Name:

Email Address:

@informationsuperhiway.net

Password:

Email Account 4

Name:

Email Address:

@informationsuperhiway.net

Password: