NetBox: Sign-Up Form


		Sign Up for NetBox Welcome to NetBox. In order to establish your permanent anchor in the cyberworld, we need some information from you. Most important is how you want to be known on the net from now on - well, at least as long as you use NetBox - as well as your real world contact points, how you want to be billed and various options available, including POP mail service. All of the information on this form is private and confidential. If you are concerned about giving this information on-line, feel free to request the e-mail version or print out the printable version, and fax it to us at 1-415-324-0998 or call us at 1-800-9NetBox [1-800-963-8269; +1-415-961-4880 from outside the U.S.]. Completing this form does imply some obligations on your part. It is important that you read the Acceptable Use Policy. Please feel free to contact us via e-mail at P_O_Master@netbox.com if you have any questions or comments. Now, let's get your NetBox set up.
		Real World Name: `First MI Last` Real World Address: `Street Address 1 Street Address 2 City State/Province Postal Code Country` Phone Contact Points: Home Phone Number Business Phone Number Fax Number I prefer to be contacted at: Home or Work Virtual World Address: In other words, your current e-mail address. You can also list up to three e-mail addresses that you might also use. Your account will be set up so that mail will be routed to each of the addresses you provide. This can be changed after your account is set up using the various configuration options. Primary e-mail address: Alternate e-mail address 1: Alternate e-mail address 2: OR Check here if you do not currently have an e-mail address or want only telnet access. Telnet only e-mail access, no redirection Your NetBox Identity This is the name you would like your NetBox to have as your personal, permanent address. Giving us three choices increases the odds that one of them is available. Account names are limited to 8 alphanumeric characters. NetBox Address: 1st Choice 2nd Choice 3rd Choice Name/Handle to appear in E-Mail Messages: If nothing is entered, your real name from above will appear on e-mail send from your NetBox. Password: [Please choose a password of 6-12 characters with at least 1 number and 1 letter.] Please enter again for confirmation: NetBox Account Plan NetBox has two basic membership plans plus the POP option: Annual PrePaid Plan -- BasicUS$18.00 -- POPUS$36.00 Special 2 Year PrePaid Plan -- BasicUS$24.00 -- POPUS$48.00 There is a onetime $25.00 ($35.00 with POP service option) sign-up fee for all plans. All three include one NetBox address, 3MB of space for e-mail, routing of all e-mail through your NetBox, and a permanent place in CyberSpace. Method of Payment Payment Details Credit Cards If you are not comfortable with using your card on the web, please do not fill in the following information; send the form and call NetBox at 1-800-9-NetBox (1-800-963-8269; 1-415-961-4880 outside the US). You can also use the printable sign-up form. Card Number Expiration (Month/Year) Issuing Bank Check Payment US Funds from a US Banks only, please. Checks should be made out to NetBox, Inc 483 Channing Avenue Palo Alto, CA 94301 USA Not available for the monthly plan; please allow 2-3 weeks for clearance before you NetBox is activated. Please contact us for alternate cash payment methods. *Where did you hear about NetBox?* When your done, just push this button to . Made a mistake? Push to start over.
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