Please fill out this application and mail to the address below. Our fees for Business Accounts are $30/month payable monthly in advance which includes a wireless Internet connection and e-mail. Billing notification will be by e-mail only to your Michiana Free-Net e-mail mailbox. The one-time initial setup fee is waived. To establish your account, your application must be accompanied by a minimum payment of $30.00. Access is unlimited. Your customers will be able to access the Internet with their laptops by giving them the user id and password listed below for your account.

ACCOUNT INFORMATION PLEASE PRINT OR TYPE

	I would like to sign up for a basic Internet connection and e-mail.	_____________________________________________ Name
	REQUIRED: I would like my User ID to be: (small letters, not less than 5 & not more than 8 characters) __________________________________________________	_____________________________________________ Address
	REQUIRED: I would like my password to be (small letters at least 5 & not more than 8 characters, use some numbers, $ or % if possible)______________________.	_____________________________________________ CityStateZip
	I would like to sign up for business Web pages. It is an additonal $5/month.	_____________________________________________ Telephone: WorkHome
	I understand the Free-Net depends on underwriters to maintain its services. I would like to contribute $__________________	IMPORTANT!!!
	I would like Wireless Internet______
	I am under 18 and would like an account. Parent's Signature_________________________________	I have iMac Mac 8.5+ Windows 95 Windows 98 Windows ME Windows 2000 Windows XP

METHOD OF PAYMENT

Monthly

Quarterly

Semi-annually

Annually

Totals:

Check enclosed made payable to
Michiana Free-Net Society, Inc.Basic Connect Fee: __________

Please charge my: VISA Mastercard	Fees for Web pages: __________
_________________________________________ Account No.Expiration Date	Donations:__________________
______________________________________ Signature	Grand Total:__________

**I have read all 4 pages of the User Service Agreement, and agree to abide by the rules set forth in it. Signature is required

Signature__________________________________________________________ Date:___________________________