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| <html> | |
| <head> | |
| <meta http-equiv="Content-Type" content="text/html; charset=windows-1252"> | |
| <meta name="GENERATOR" content="Microsoft FrontPage 4.0"> | |
| <meta name="ProgId" content="FrontPage.Editor.Document"> | |
| <title>Signup</title> | |
| <!--mstheme--><link rel="stylesheet" type="text/css" href="_themes/copy-of-classic-2/copy1110.css"><meta name="Microsoft Theme" content="copy-of-classic-2 1110, default"> | |
| <meta name="Microsoft Border" content="b, default"> | |
| </head> | |
| <body><!--msnavigation--><table border="0" cellpadding="0" cellspacing="0" width="100%"><tr><!--msnavigation--><td valign="top"> | |
| <p align="center"><!--webbot bot="Navigation" S-Type="banner" S-Rendering | |
| S-Orientation B-Include-Home B-Include-Up U-Page S-Target startspan --><img src="_derived/signup.htm_cmp_copy-of-classic-2110_bnr.gif" width="600" height="60" border="0" alt="Signup"><!--webbot bot="Navigation" endspan i-checksum="29259" --> | |
| </p> | |
| <form METHOD="POST" action="_vti_bin/shtml.dll/signup.htm" onSubmit webbot-action="--WEBBOT-SELF--"> | |
| <!--webbot bot="SaveResults" startspan U-File="_private/signup.txt" | |
| S-Format="TEXT/PRE" S-Label-Fields="TRUE" B-Reverse-Chronology="FALSE" | |
| S-Email-Format="TEXT/PRE" S-Email-Address="willjs@bci1.com" | |
| B-Email-Label-Fields="TRUE" B-Email-Subject-From-Field="FALSE" | |
| S-Email-Subject="HyperHog Signup form" S-Builtin-Fields="HTTP_USER_AGENT" | |
| U-Confirmation-Url="thankyou.htm" --><input TYPE="hidden" NAME="VTI-GROUP" VALUE="0"><!--webbot | |
| bot="SaveResults" endspan i-checksum="43374" --> | |
| <p><a NAME="Question-1"><font size="4"><b>Please provide the following contact | |
| information:</b></font></a></p> | |
| <table> | |
| <tr> | |
| <td ALIGN="right"><em><b>First Name</b></em></td> | |
| <td><input TYPE="TEXT" NAME="Contact_FirstName" SIZE="25"></td> | |
| </tr> | |
| <tr> | |
| <td ALIGN="right"><em><b>Last Name</b></em></td> | |
| <td><input TYPE="TEXT" NAME="Contact_LastName" SIZE="25"></td> | |
| </tr> | |
| <tr> | |
| <td ALIGN="right"><em><b>Title</b></em></td> | |
| <td><input TYPE="TEXT" NAME="Contact_Title" SIZE="35"></td> | |
| </tr> | |
| <tr> | |
| <td ALIGN="right"><em><b>Organization Name</b></em></td> | |
| <td><input TYPE="TEXT" NAME="Contact_Organization" SIZE="35"></td> | |
| </tr> | |
| <tr> | |
| <td ALIGN="right"><em><b>Physical Street Address</b></em></td> | |
| <td><input TYPE="TEXT" NAME="Contact_StreetAddress" SIZE="35"></td> | |
| </tr> | |
| <tr> | |
| <td ALIGN="right"><em><b>Address (cont.)</b></em></td> | |
| <td><input TYPE="TEXT" NAME="Contact_Address2" SIZE="35"></td> | |
| </tr> | |
| <tr> | |
| <td ALIGN="right"><em><b>City</b></em></td> | |
| <td><input TYPE="TEXT" NAME="Contact_City" SIZE="35"></td> | |
| </tr> | |
| <tr> | |
| <td ALIGN="right"><em><b>State/Province</b></em></td> | |
| <td><input TYPE="TEXT" NAME="Contact_State" SIZE="35"></td> | |
| </tr> | |
| <tr> | |
| <td ALIGN="right"><em><b>Zip/Postal Code</b></em></td> | |
| <td><input TYPE="TEXT" NAME="Contact_ZipCode" SIZE="12" MAXLENGTH="12"></td> | |
| </tr> | |
| <tr> | |
| <td ALIGN="right"><i><b>Mailing/Billing Address</b></i></td> | |
| <td><input TYPE="TEXT" NAME="Contact_StreetAddress1" SIZE="35"></td> | |
| </tr> | |
| <tr> | |
| <td ALIGN="right"><i><b>City</b></i></td> | |
| <td><input TYPE="TEXT" NAME="Contact_City1" SIZE="35"></td> | |
| </tr> | |
| <tr> | |
| <td ALIGN="right"><i><b>State/Province</b></i></td> | |
| <td><input TYPE="TEXT" NAME="Contact_State1" SIZE="35"></td> | |
| </tr> | |
| <tr> | |
| <td ALIGN="right"><i><b>Zip/Postal Code</b></i></td> | |
| <td><input TYPE="TEXT" NAME="Contact_ZipCode1" SIZE="12" MAXLENGTH="12"></td> | |
| </tr> | |
| <tr> | |
| <td ALIGN="right"><em><b>Work Phone</b></em></td> | |
| <td><input TYPE="TEXT" NAME="Contact_WorkPhone" SIZE="25" MAXLENGTH="25"></td> | |
| </tr> | |
| <tr> | |
| <td ALIGN="right"><em><b>Home Phone</b></em></td> | |
| <td><input TYPE="TEXT" NAME="Contact_HomePhone" SIZE="25" MAXLENGTH="25"></td> | |
| </tr> | |
| <tr> | |
| <td ALIGN="right"><em><b>FAX</b></em></td> | |
| <td><input TYPE="TEXT" NAME="Contact_FAX" SIZE="25" MAXLENGTH="25"></td> | |
| </tr> | |
| <tr> | |
| <td ALIGN="right"><em><b>E-mail</b></em></td> | |
| <td><input TYPE="TEXT" NAME="Contact_Email" SIZE="25"></td> | |
| </tr> | |
| <tr> | |
| <td ALIGN="right"><em><b>URL</b></em></td> | |
| <td><input TYPE="TEXT" NAME="Contact_URL" SIZE="25" MAXLENGTH="25"></td> | |
| </tr> | |
| </table> | |
| <b><font size="4"><br> | |
| Please complete the billing information below:</font></b> | |
| <table> | |
| <tr> | |
| <td><em>Billing Method</em> | |
| </td> | |
| <td><select NAME="Billing_Method" size="1"> | |
| <option>Check</option> | |
| <option>Cash</option> | |
| <option SELECTED>VISA | |
| <option>MasterCard | |
| <option>American Express | |
| <option>Discover | |
| <option>Diner's Club | |
| </select></td> | |
| </tr> | |
| <tr> | |
| <td><i>Account Type</i></td> | |
| <td><select size="1" name="Account_Type"> | |
| <option>Individual</option> | |
| <option>Business</option> | |
| <option>Commercial</option> | |
| </select></td> | |
| </tr> | |
| </table> | |
| <p> </p> | |
| <b><font size="4">Select the HyperHog access service from the list below:</font></b> | |
| <ul> | |
| <li><select NAME="Service_Type" size="1"> | |
| <option SELECTED>56k Modem DialUp, 1 login/customer - $19.95/month | |
| <option>ISDN DialUp - 64k, 250 hrs, 1 login/customer - $39/month | |
| <option>ISDN DialUp - 128k, 500 hrs, 1 login/customer - $70/month | |
| <option>ISDN Dedicated 64k - $100/month | |
| <option>ISDN Dedicated 128k - $175/month | |
| <option>Wireless Internet - 128k Dedicated, 1 IP address, 2 email accts. | |
| - $49.95/month | |
| <option>Wireless Internet - 256k Dedicated, 1 IP address, 2 email accts. | |
| - $79.95/month | |
| <option>Wireless Internet - 512k Dedicated, 1 IP address, 2 email accts. | |
| - $99.95/month | |
| <option>Wireless Internet - 1.54mb Dedicated, 1 IP address, 2 email | |
| accts. - $249.95/month | |
| <option>Commercial Wireless Internet - 128k Dedicated, 4 IP addresses, | |
| 10 email accts. - $99.95/month | |
| <option>Commercial Wireless Internet - 256k Dedicated, 4 IP addresses, | |
| 10 email accts. - $149.95/month | |
| <option>Commercial Wireless Internet - 512k Dedicated, 4 IP addresses, | |
| 15 email accts. - $249.95/month | |
| <option>Commercial Wireless Internet - 1.54mb Dedicated, 4 IP addresses, | |
| 15 email acct., 1-15 users - $299.95/month | |
| <option>Commercial Wireless Internet - 1.54mb Dedicated, 4 IP addresses, | |
| 20 email accts., 16-30 users - $399.95/month | |
| <option>Commercial Wireless Internet - 1.54mb Dedicated, 4 IP addresses, | |
| 30 email accts., 31-up users - $499.95/month | |
| </select><br> | |
| </li> | |
| </ul> | |
| <p><font size="4"><b>Web Page Design Services</b> </font>- <a NAME="Question-5">Select | |
| any of the following options that apply.</a></p> | |
| <ul> | |
| <li> | |
| <p style="line-height: 150%; margin-top: 3; margin-bottom: 3"><input TYPE="CHECKBOX" NAME="50MB-Website" value="Yes"> | |
| <b>50 MB Web Site</b> (www.yourdomain.com) One-time set-up fee $49.00 plus | |
| Internic fee. Monthly fee $39. </p> | |
| </li> | |
| <li> | |
| <p style="line-height: 150%; margin-top: 3; margin-bottom: 3"><input TYPE="CHECKBOX" NAME="75MB-Website" value="Yes"> | |
| <b>75 MB Web Site</b> (www.yourdomain.com) One-time set-up fee $49.00 plus | |
| Internic fee. Monthly fee $49. </p> | |
| </li> | |
| <li> | |
| <p style="line-height: 150%; margin-top: 3; margin-bottom: 3"><input TYPE="CHECKBOX" NAME="Custom-Website-5-pages" value="Yes"> | |
| <b>Custom Web Page Design</b> - 5 page account. Initial fee | |
| $100 for up to 10 hrs labor. $25/hour thereafter. | |
| </p> | |
| </li> | |
| <li> | |
| <p style="line-height: 150%; margin-top: 3; margin-bottom: 3"> | |
| <input TYPE="CHECKBOX" NAME="Custom-Website-10-pages" value="ON"> | |
| <b>Custom Web Page Design</b> - 10 page account. Initial fee $175 for up | |
| to 15 hrs labor. $25/hour thereafter.<br> | |
| </p> | |
| </li> | |
| </ul> | |
| <input TYPE="SUBMIT" VALUE="Submit Form"> <input TYPE="RESET" VALUE="Reset Form"> | |
| </form> | |
| <!--msnavigation--></td></tr><!--msnavigation--></table><!--msnavigation--><table border="0" cellpadding="0" cellspacing="0" width="100%"><tr><td> | |
| <hr align="left" width="98%"> | |
| <p><font size="2"><nobr>[ <a href="./">Home</a> ]</nobr> <nobr>[ <a href="services.htm">Internet Access</a> ]</nobr> <nobr>[ <a href="web_services.htm">Web Hosting & Design</a> ]</nobr> <nobr>[ <a href="faq.htm">FAQs</a> ]</nobr> <nobr>[ Signup ]</nobr> <nobr>[ <a href="feedback.htm">Feedback</a> ]</nobr> | |
| </font><font size="1"><br> | |
| Send mail to <a href="mailto:willjs@bci1.com">willjs@bci1.com</a> with questions or | |
| comments about this web site.<br> | |
| Copyright © 2000 HyperHog Internet Access<br> | |
| Last modified: June 26, 2000</font></p> | |
| </td></tr><!--msnavigation--></table></body> | |
| </html> |