VTel Internet

Referred by:

(Full VTel Internet Email address)

Billing Name:  Example: Jane Q. Surfer
     Address:  Example: 123 Main Street
        Town:  Example: Springfield
       State:   Zip:  Example: 05155-0001


   Telephone:  Example: 802-555-1212

 Are you a current customer?  Yes   No

       User Name:  (Name for log-in - 3 to 12 characters)
You may request additional optional mailboxes: 

(up to 5)
 Add'l Mailbox 1:  (Name for Add'l Mailbox - 3 to 12 characters)
 Add'l Mailbox 2:  (Name for Add'l Mailbox - 3 to 12 characters)
 Add'l Mailbox 3:  (Name for Add'l Mailbox - 3 to 12 characters)
 Add'l Mailbox 4:  (Name for Add'l Mailbox - 3 to 12 characters)
 Add'l Mailbox 5:  (Name for Add'l Mailbox - 3 to 12 characters)
   Computer Type:  PC   Mac

Operating System: 
                 Windows 3.1 (Shareware available)
                 Windows 95/98/NT
                 Windows ME
                 Windows XP
                 System 7.5 or Higher

Houshold Account

Payment Options:  

1 to 5 months at $21.95 per month
6 or 12 months at $19.95 per month
   I'll send a Check.
   Please charge my Mastercard monthly.
   Please charge my Visa monthly.

If you have chosen to pay by credit card, we will ask that you
provide the credit card number and expiration date when we
contact you with your password.

Comments?