Stickdog Dialup Service Order Form

Requested Dialup Plan                        Monthy rate             Setup Fee
150 Hours per Month world.net details     $18.95                  $ 7.00
200 Hours per Month pop.net details       $18.95                  $ 7.00
Unlimited Access usa details                  $18.95                  $ 7.00
Filtered Access details                          $24.95                 $22.00
Static IP Account details                      $26.95                  $ 7.00
Single-channel ISDN details                   $18.95                  $ 7.00
Dual-channel ISDN details                     $37.90                  $14.00
Dual-channel ISDN with Static IP details $45.90                  $22.00
Multi Link Access details                       $28.95                  $14.00

Desired Password for dial-up

Desired username and passwordfor email accounts: (ex. username@stickdog.com)
Please note: usernames must begin with a letter, be less than 12 characters long and may contain only letters and numbers!

username #1 password
username #2 password
username #3 password
username #4 password
username #5 password
username #6 password
username #7 password
username #8 password
username #9 password
username #10 password

If desired, please enter your preferred username for free 5 MB space to host your personal page:
http://www.stickdog.com/
If you entered a username for your free web space, please enter your desired password for FTP:

AUTHORIZATION & AGREEMENT: Subscriber agrees to use Internet in compliance with all applicable laws and to indemnify and hold Stickdog harmless for any loss incurred by Stickdog or Stickdog's suppliers as a result of Subscriber's use of Stickdog's service. Subscriber agrees to pay fees in accordance with Stickdog's rate schedule listed above, and revisions thereto, provided that Stickdog provides notice to Subscriber of any rate increase at least 60 days prior to next payment due date.
I agree

	Dialup Access Service Order Form
	Date: 01-06-2009
Company Name: First Name: Last Name: E-mail address: Telephone Number: Street Address: City: State: Zip: Billing Address: same as the Service Address If different from the Service Address: Billing Address: City: State: Zip: Requested Dialup Plan Monthy rate Setup Fee 150 Hours per Month world.net details $18.95 $ 7.00 200 Hours per Month pop.net details $18.95 $ 7.00 Unlimited Access usa details $18.95 $ 7.00 Filtered Access details $24.95 $22.00 Static IP Account details $26.95 $ 7.00 Single-channel ISDN details $18.95 $ 7.00 Dual-channel ISDN details $37.90 $14.00 Dual-channel ISDN with Static IP details $45.90 $22.00 Multi Link Access details $28.95 $14.00 Desired Password for dial-up Desired username and passwordfor email accounts: (ex. username@stickdog.com) Please note: usernames must begin with a letter, be less than 12 characters long and may contain only letters and numbers! username #1 password username #2 password username #3 password username #4 password username #5 password username #6 password username #7 password username #8 password username #9 password username #10 password Additional Email Boxes $1.00 Number of additional email boxes needed If desired, please enter your preferred username for free 5 MB space to host your personal page: http://www.stickdog.com/ If you entered a username for your free web space, please enter your desired password for FTP: AUTHORIZATION & AGREEMENT: Subscriber agrees to use Internet in compliance with all applicable laws and to indemnify and hold Stickdog harmless for any loss incurred by Stickdog or Stickdog's suppliers as a result of Subscriber's use of Stickdog's service. Subscriber agrees to pay fees in accordance with Stickdog's rate schedule listed above, and revisions thereto, provided that Stickdog provides notice to Subscriber of any rate increase at least 60 days prior to next payment due date. I agree