- MONON TELEPHONE COMPANY, INC.®
- (219)253-6601 (OFFICE) (800)531-7121/
(219)253-7500 (FAX)
- Dial-up Internet Application
The following information must be provided in
full for an account to be established. This form is an agreement
for service under a specific set of terms and conditions, between
Monon Telephone Company, Inc.® and the undersigned.
- Your
Name:_________________________________________________________________
- Company
Name:______________________________________________________________
Address:____________________________________________________________________
- City, State, Zip
Code:__________________________________________________________
- Telephone
Number:(Home)_____________________(Work)___________________________
- Date:________________
User Name for
Internet Access (3 to 16 characters)
_____________________(must be lower case) (Please print clearly)
- Password
for Internet Access (5 to 8
characters)____________________ (Please print clearly)
Account Type (billed monthly): There is No
Charge to sign up to the Internet_____ Usage Basis Billing:
- HOURS PER MONTH___________ COST
- 0-5__________________________$10.00
- 5.1 -
15_______________________$15.00
- 15.1 -
25______________________$20.00
- 25.1 -
100_____________________$25.00
- 100.1 -
200____________________$30.00
- 200.1 -
300____________________$35.00
- 300.1 - +__________.50 per hour
over 300
- Minimum per Month of $10.00
-
I
HAVE READ THIS DOCUMENT AND AGREE TO THE TERMS AND
CONDITIONS STATED. I AFFIRM THAT I AM LEGALLY QUALIFIED
TO CONTRACT AND HAVE ATTAINED THE AGE OF AT LEAST 18
YEARS. I WILL NOT PLACE NOR DISTRIBUTE NUDE OR
PORNOGRAPHIC CONTENT ON THIS INTERNET SERVER. I
UNDERSTAND THAT THIS CONTRACT IS BETWEEN MONON TELEPHONE
COMPANY, INC.® AND THE UNDERSIGNED.
- Signature:
_________________________________________ Driver License Number:_______________________
- Date of
Birth: _______/______/______
Your service will be
activated within 24 hours of receiving your account
application. ========================================================================================
OFFICE USE ONLY
- Order received by
:_______________________ Date: ____/____/____
Time: ____:____
- Service Order #:
_________________________ Date: ___/___/___
- Set up on Server as a User:
____/____/____ Time: ____:____ By:
________________