Registration Form

Please fill out the following form completely. You can either click Submit when you are done filling out the form or print this page and mail or fax it to our office. Accounts paid by check are billed quarterly in advance and are activated upon receipt of the first payment. Please Make checks payable to 95Net, Inc.

Personal Information
Bold Text lines are required. Use Tab to move between lines.

Your Name

Company

Street Address

City

Zip Code

Phone

Fax

Current E-Mail

User Name requested

Password

Confirm Password

A credit card is required to activate accounts immediately. Accounts paid by check are activated upon receipt of the 1st payment.

Card No.
Exp Date

Account Information
Please select your account type and check the appropriate boxes below.

Account Type

Personal Business

Click below for more details on each service
*Dial-Up PPP ( 14.4 - 56K )**	Unlimited Hours 56K* Unlimited Hours ( 33.6K max )
Dial-Up ISDN	100 B Channel Hours 200 B Channel Hours 64K Unlimited 128K Unlimited
Local Area Network ISDN	100 B Channel Hours 200 B Channel Hours 64K Unlimited 128K Unlimited
Dedicated Connections	Analog ( 14.4-56K ) 64K ISDN 128K ISDN
Web Hosting*	Web Starter Web Basic

*Web Hosting does not include InterNIC registration fees. Currently, they are $70 for the first 2 years, and $35 for every year thereafter.

Comments and Notes

Click below to submit via E-Mail. By setting up an account with 95Net, you agree to abide by the terms set forth in the 95Net User Agreement. 95Net will contact you to provide further assistance and information as necessary to help setup the account.

To submit by Fax:

95Net, Inc.
( 775 ) 255-8719