Name:
Address:
City:
State:
Zip:
Day Phone:
Night Phone:
Desired Account # (usually your 10-digit phone number):
Desired Passcode (must be all numbers):
Re-enter password for verification:
What Service Plan would you like? Please note that if you select
any of the limited time plans, you will be allowed 3 hours per
month. Additional minutes cost 10 cents each.
Email only -- your own mailbox ($8.95/mo.)
Email & Usenet -- your own mailbox ($11.95/mo.)
Email only -- mailbox on our server ($11.95/mo.)
Email & Usenet -- mailbox on our server ($14.95/mo.)
Web only ($8.95/mo.) Web & Usenet ($11.95/mo.)
Email & Web -- your own mailbox ($11.95/mo.)
Email, Web and Usenet -- your own mailbox ($14.95/mo.)
Email & Web -- box on our server ($14.95/mo.)
Email, Web, and Usenet -- mailbox on our server ($17.95/mo.)
Email & Web, unlimited time -- your own mailbox ($26.95/mo.)
Email, Web, and Usenet, unlimited time, your own mailbox ($29.95)
Email & Web, unlimited time -- mailbox on our server ($29.95/mo.)
Email, Web, and Usenet, unlimited time, mailbox on our server ($32.95/mo.)
Check here if you want toll-free access for 20 cents per minute.
Please be aware that prices quoted here are
monthly service fees, with the first month billed in advance
when you sign up for service. Charges for minutes used over
the allowed time for limited time plans are billed following
the month the minutes are used. Unused minutes may not be
carried over to the next month. You may cancel service at
any time and you will only be charged for service and
overtime minutes used in the current 30-day billing cycle.
POP Email Server Information
Fill in the POP Server Address and POP
Password boxes below only if you wish to use voice email with
a mailbox provided by your own ISP (Internet Service Provider).
Most ISPs that offer standard internet access will allow POP
access to your mailbox, and will work with our system. Yahoo
accounts will work if POP access is enabled. (See the Yahoo
Mail pages for more information.) AOL and some free email
accounts are not supported. If you choose to use a mailbox
on our server, fill in the Username below with the name you
would like to use for your email address. Your email address
will then be(chosen username)@philmore.com
Your POP Server Address (e.g. pop.philmore.com):
Your POP Username: Your POP Password:
Re-enter your POP Password for verification:
Payment Information
Charge my Credit Card
Card Type
Visa
MasterCard
American Express
Discover
Card Number:
Name On Card:
Expiration Date:
Jan.
Feb.
Mar.
Apr.
May
Jun.
Jul.
Aug.
Sep.
Oct.
Nov.
Dec.
1999
2000
2001
2002
2003
2004
2005
Debit my Checking Account
Routing Code (1st 9 digits in lower-left corner of
check)
Bank Account Number (next group of digits, disregard
check number)
Where did you hear about us?
Radio Ad
Newspaper Ad
TV Ad
Email Ad
Postal Mail Ad
Billboard/Poster Ad
Other (please specify below)
Once you sign up for service using this
form, a customer service representative will contact you within
24 hours to furnish you with your account information, access
telephone number, and answer any questions you may have about
our service.