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<html><!-- #BeginTemplate "/Templates/4fam-main.dwt" -->
<head>
<title>4fam: Porn-Free Internet </title>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">
</head>
<body bgcolor="#FFFFFF">
<div align="left"></div>
<table width="98%" border="0" cellspacing="0" cellpadding="4" align="center">
<tr bgcolor="eeeeee">
<td align="right" width="120" bgcolor="#f1f1f1" valign="top"><a href="http://www.mics.net:8080/church"><img src="churchlocator.gif" width="96" height="78" align="bottom" border="0"></a></td>
<td bgcolor="#f1f1f1" valign="top">
<div align="center"> <img src="4fam_net.GIF" width="255" height="83"></div>
</td>
<td width="120" align="left" bgcolor="#f1f1f1" valign="top"><a href="help/index.html"><img src="help.gif" width="80" height="73" align="bottom" border="0"></a></td>
</tr>
<tr>
<td align="right" colspan="3" bgcolor="#f1f1f1" valign="top">
<div align="center"> <font face="Arial, Helvetica, sans-serif"><a
href="http://www.get4fam.com/personal.html" target="_blank"><font size="2">Family
Services</font></a> <font size="2">&nbsp;&nbsp;&nbsp;&nbsp;<a
href="http://www.get4fam.com/business.html" target="_blank">Business Services</a>
&nbsp;&nbsp;&nbsp;&nbsp;<a href="http://www.get4fam.com/church.html">Church
&amp; Non-Profit Services</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <a
href="http://www.get4fam.com/servicearea.html" target="_blank">Service Area</a>&nbsp;&nbsp;&nbsp;
<a href="http://www.4fam.net/check" target="_blank"><br>
LiteLine&#153; Check</a>&nbsp;&nbsp;&nbsp;&nbsp; <a href="http://www.get4fam.com/porn-free.html" target="_blank">Why
Us?</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<a href="http://www.get4fam.com/aboutus.html" target="_blank">About
Us</a> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <a href="http://www.get4fam.com/aup.html"
target="_blank">Acceptable Use Policy </a>&nbsp;&nbsp;&nbsp;&nbsp;<a
href="http://www.get4fam.com/sign-up.html" target="_blank">Sign-Up</a> &nbsp;&nbsp;&nbsp;<a href="mailto:staff@mics.net">E-mail
Us</a> &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<a href="addurl.html">Add Link</a></font></font></div>
</td>
</tr>
<tr>
<td align="right" width="120" bgcolor="#f1f1f1" valign="top">
<h5><font face="Arial, Helvetica, sans-serif"><a href="addurl.html" target="_blank">Add
4fam Link </a></font></h5>
<h5><font face="Arial, Helvetica, sans-serif"><a href="automotive.html">Automobiles</a></font></h5>
<h5><a href="computers.html"><font face="Arial, Helvetica, sans-serif"><a href="../christian.html">Christian</a></font></a></h5>
<h5><a href="computers.html"><font face="Arial, Helvetica, sans-serif">Computers</font></a></h5>
<h5><a href="daytonarea.html"><font face="Arial, Helvetica, sans-serif">Dayton
Area</font></a></h5>
<h5><a href="financial.html"><font face="Arial, Helvetica, sans-serif">Financial</font></a></h5>
<h5><a href="garden.html"><font face="Arial, Helvetica, sans-serif">Home
&amp; Garden</font></a></h5>
<h5><a href="justforkids.html"><font face="Arial, Helvetica, sans-serif">Just
4 Kids</font></a></h5>
</td>
<td valign="top">
<div align="center"> <!-- #BeginEditable "top" -->
<h3><font face="Arial, Helvetica, sans-serif" color="#3366FF">Productivity-Enhanced
DSL&#153;<br>
Pre-Qualifiaction Form</font></h3>
<h4 align="left"><font face="Arial, Helvetica, sans-serif" color="#000000">Please
note:</font></h4>
<div align="left">
<ul>
<li><font face="Arial, Helvetica, sans-serif" color="#000000">Incomplete
information will result in a failure to assess DSL capability for
your location.<br>
<br>
</font></li>
<li>I<font face="Arial, Helvetica, sans-serif" color="#000000">ncorrect
information will result in an inaccurate assessment of capabilities
available.</font> </li>
</ul>
<FORM NAME="DSL_Check" ACTION="http://www.mics.net/cgi-bin/FormMail.pl" METHOD="POST" ENCTYPE="x-www-form-urlencoded">
<INPUT TYPE="hidden" NAME="redirect" VALUE="http://www.4fam.net/dslthank.html">
<INPUT TYPE="hidden" NAME="recipient" VALUE="wayne@mics.net">
<INPUT TYPE="hidden" NAME="subject" VALUE="DSL Check">
<INPUT TYPE="hidden" NAME="required" VALUE="RealName,CompanyName,area,exchange,number,email,street,city,st,zip_code,dsl_area,dsl_exchange,dsl_number,how_hear">
<table width="90%" border="0" cellspacing="0" cellpadding="5">
<tr>
<td colspan="2">
<h4 align="center"><font face="Arial, Helvetica, sans-serif" color="#3366FF">Contact
Information</font></h4>
</td>
</tr>
<tr>
<td>
<div align="right"><font face="Arial, Helvetica, sans-serif">Contact
Name </font></div>
</td>
<td> <font face="Arial, Helvetica, sans-serif">
<input type="text" name="RealName" size="40">
</font></td>
</tr>
<tr>
<td>
<div align="right"><font face="Arial, Helvetica, sans-serif">Company
Name</font></div>
</td>
<td> <font face="Arial, Helvetica, sans-serif">
<input type="text" name="CompanyName" size="40">
</font></td>
</tr>
<tr>
<td><font face="Arial, Helvetica, sans-serif">Telephone #</font></td>
<td><font face="Arial, Helvetica, sans-serif"> (
<input type="text" name="area" size="3" maxlength="3">
)
<input type="text" name="exchange" size="3" maxlength="3">
-
<input type="text" name="number" size="4" maxlength="4">
</font></td>
</tr>
<tr>
<td>
<div align="right"><font face="Arial, Helvetica, sans-serif">e-mail
address</font></div>
</td>
<td>
<input type="text" name="email" size="40">
</td>
</tr>
<tr>
<td colspan="2">
<h4 align="center"><font face="Arial, Helvetica, sans-serif" color="#3366FF">Information
about the DSL Location</font></h4>
</td>
</tr>
<tr>
<td>
<div align="right"><font face="Arial, Helvetica, sans-serif">Street
Address</font></div>
</td>
<td>
<p> <font face="Arial, Helvetica, sans-serif">
<input type="text" name="street" size="40">
</font></p>
</td>
</tr>
<tr>
<td>
<div align="right"><font face="Arial, Helvetica, sans-serif">City</font></div>
</td>
<td><font face="Arial, Helvetica, sans-serif">
<input type="text" name="city">
</font></td>
</tr>
<tr>
<td>
<div align="right"><font face="Arial, Helvetica, sans-serif">State</font></div>
</td>
<td><font face="Arial, Helvetica, sans-serif">
<input type="text" name="st" size="3" maxlength="2">
</font></td>
</tr>
<tr>
<td>
<div align="right"><font face="Arial, Helvetica, sans-serif">Zip
Code</font></div>
</td>
<td><font face="Arial, Helvetica, sans-serif">
<input type="text" name="zip_code" size="5" maxlength="5">
</font></td>
</tr>
<tr>
<td>
<div align="right"><font face="Arial, Helvetica, sans-serif">Telephone
#</font></div>
</td>
<td><font face="Arial, Helvetica, sans-serif">(
<input type="text" name="dsl_area" size="3" maxlength="3">
)
<input type="text" name="dsl_exchange" size="3" maxlength="3">
-
<input type="text" name="dsl_number" size="4" maxlength="4">
</font></td>
</tr>
<tr>
<td>
<div align="right"><font face="Arial, Helvetica, sans-serif">How
did you hear about us?</font></div>
</td>
<td>
<input type="text" name="how_hear" size="40">
</td>
</tr>
<tr>
<td colspan="2">
<div align="center">
<input type="submit" name="Submit" value="Submit">
<hidden input type="submit" name="Submit2" value="Submit2">
</div>
</td>
</tr>
</table>
</form>
<p>&nbsp;</p>
</div>
<!-- #EndEditable --></div>
</td>
<td width="120" align="left" bgcolor="#f1f1f1" valign="top">
<h5><font face="Arial, Helvetica, sans-serif"><a href="news.html" target="_blank">News</a></font></h5>
<h5><a href="shipping.html"><font face="Arial, Helvetica, sans-serif">Shipping
Info</font></a></h5>
<h5><a href="search.html"><font
face="Arial, Helvetica, sans-serif">Search Page</font></a></h5>
<h5><a href="software.html"><font face="Arial, Helvetica, sans-serif">Software</font></a></h5>
<h5><a href="sports.html"><font face="Arial, Helvetica, sans-serif">Sports</font></a></h5>
<h5><font face="Arial, Helvetica, sans-serif"><a href="virus.html">Virus
Protection</a></font></h5>
<h5><a href="weather.html" target="_blank"><font face="Arial, Helvetica, sans-serif">Weather</font></a></h5>
<h5><font face="Arial, Helvetica, sans-serif"><a href="cgi-bin/neomail.pl">Web
E-mail</a></font></h5>
</td>
</tr>
<tr>
<td align="right" width="120" bgcolor="#f1f1f1">
<p><a href="http://www.cheroes.com" target="_blank"><font face="Arial, Helvetica, sans-serif" size="2"><img src="hero.gif" width="100" height="69" border="0"><br>
Sports Stuff</font></a></p>
</td>
<td>
<div align="center"><!-- #BeginEditable "bottom" -->
<table width="90%" border="0" cellspacing="0" cellpadding="5">
<tr>
<td width="38%"><font color="#3333FF" size="6"><b><font face="Arial, Helvetica, sans-serif" size="5">D</font></b><font color="#000000" face="Arial, Helvetica, sans-serif" size="5">igital</font><font face="Arial, Helvetica, sans-serif" size="5"><br>
&nbsp;&nbsp;<b>S</b><font color="#000000">ubscriber</font><br>
&nbsp;&nbsp;&nbsp;&nbsp;<b>L</b><font color="#000000">ine</font></font></font></td>
<td width="62%">
<div align="center"><font face="Arial, Helvetica, sans-serif" color="#FF3399"><b>Order
before September 30, 2000<br>
and get a $200 rebate</b></font></div>
</td>
</tr>
</table>
<!-- #EndEditable --></div>
</td>
<td width="120" align="left" bgcolor="#f1f1f1">
<p><font face="Arial, Helvetica, sans-serif"><a href="help/modems.htm"><font face="Arial, Helvetica, sans-serif" size="2"><img
src="zoom.gif" width="72" height="72" naturalsizeflag="0" align="BOTTOM"><br>
Great Modems!</font></a> </font></p>
</td>
</tr>
<tr>
<td align="right" width="120" bgcolor="#f1f1f1"><img src="cisco.gif" width="107" height="87" naturalsizeflag="0"
align="BOTTOM"></td>
<td>
<p align="center"><a href="http://www.learninglabs.net/"><font face="Arial, Helvetica, sans-serif"><img
src="llab.gif" width="300" height="48" border="3" naturalsizeflag="0"
align="middle"><br>
</font><font face="Comic Sans MS, Arial, sans-serif" size="-1">Online
Learning - Gain Computer Skills at Home</font></a> <font size="-1">&nbsp;</font>&nbsp;
</p>
<p align="center"><font size="-2" face="Arial, Helvetica, sans-serif">Trademarks
the property of the respective company's -&nbsp;All Rights Reserved<br>
<br>
Midwest Internet Connections & Services, Inc.<br>
3481 Office Park Drive, Kettering, OH</font><font size="-2" face="Arial, Helvetica, sans-serif"><br>
Copyright &COPY; 1997-2000 All Rights Reserved.</font> </p>
</td>
<td width="120" align="left" bgcolor="#f1f1f1">
<p><img src="rsac.gif" width="96" height="31" align="absmiddle"></p>
<p><img src="lucent.gif" width="116" height="41" naturalsizeflag="0"
align="BOTTOM"></p>
</td>
</tr>
<tr bgcolor="eeeeee">
<td align="right" bgcolor="#f1f1f1" width="120">
<div align="center"><font face="Arial, Helvetica, sans-serif"><img src="images/2000server.gif" width="85" height="90">
</font></div>
</td>
<td align="right" bgcolor="#f1f1f1">
<div align="center">
<p> <font face="Arial, Helvetica, sans-serif"><img src="apache_pb.gif" width="259" height="32" align="absmiddle">
<img src="images/cflogos.gif" width="161" height="44" align="middle">
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<br>
<br>
<b><font size="-1"><a
href="http://www.get4fam.com/personal.html" target="_blank"><font size="-4">Family
Services</font></a></font><font size="-4"> &nbsp;&nbsp;&nbsp;&nbsp;<a
href="http://www.get4fam.com/business.html" target="_blank">Business Services</a>
&nbsp;&nbsp;&nbsp;&nbsp;<a href="http://www.get4fam.com/church.html"
target="_blank">Church &amp; Non-Profit Services<br>
</a><a
href="http://www.get4fam.com/servicearea.html" target="_blank">Service Area</a>&nbsp;&nbsp;&nbsp;
<a href="http://www.4fam.net/check">LiteLine&#153; Check</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
<a href="http://www.get4fam.com/porn-free.html" target="_blank">Why
Us?</a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<a href="http://www.get4fam.com/aboutus.html"
target="_blank">About Us </a><br>
&nbsp;<a href="http://www.get4fam.com/aup.html"
target="_blank">Acceptable Use Policy </a>&nbsp;&nbsp;&nbsp;&nbsp;<a
href="http://www.get4fam.com/sign-up.html" target="_blank">Sign-Up</a> &nbsp;&nbsp;&nbsp;&nbsp;<a href="mailto:staff@mics.net">E-mail
Us</a></font></b> <font size="-4"><br>
<a href="addurl.html">Add URL to Home Page</a><br>
</font> </font></p>
</div>
</td>
<td align="right" bgcolor="#f1f1f1" width="120">
<div align="center"><font face="Arial, Helvetica, sans-serif"><img src="images/frontpage.gif" width="88" height="58"></font></div>
</td>
</tr>
</table>
<div align="center"></div>
<div align="center"></div>
</body>
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