Welcome To NetBox

 - your permanent place in CyberSpace. 

NetBox Sign-up Form


        Print this form and use it for setting up your NetBox account.



Real World Address



Name:		  ____________________________________________


Street 1:	  ____________________________________________

Street 2:	  ____________________________________________

City:		  ____________________________________________

State/Prov:	  ____________________________________________

Postal Code:	  ________________	Country:  __________________



Phone Number:	____________________(Home)	

		____________________(Office)

Fax Number:	____________________


Preferred Contact (Home or Office): ________


Virtual World Address

Your current e-mail address(es). You can list up to three e-mail addresses 
that you usually 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:	_____________________________



NetBox Identity

This is the name you would like your netbox to have as your personal, 
permanent address. Please give us three choices so we have a good chance 
one of them is available. This account name is limited to 8 digits and is 
not case sensitive.

NetBox Address 1: ______________  2: ______________	3: ______________

Password:	_________________ 
	(Minimum of 6 characters with at least 1 number and 1 alphabetic)

You also have the option of choosing the name that will appear on e-mail 
sent through your NetBox. If you do not enter any name, your real name from 
above will be used.

E-Mail Name:	_________________


NetBox Account Plan

NetBox has three basic membership plans: Monthly Service, Annual Prepaid 
Plan and the Two Year Special Plan. For all plans, there is a one time 
US$25 set-up fee. All three include one NetBox address, 3MB of space for 
e-mail in transit, 15 hours/month of telnet time for handling your mail, 
routing of e-mail, and a permanent place in CyberSpace.

Please choose the plan you prefer:

  [ ] Monthly Plan 		- US$2.00/month			$________

  [ ] Annual Plan 		- US$18.00 (US$1.50/month)	$________

  [ ] Special Two Year Membership - US$24.00 (US$1.00/month)	$________

  Set Up Charge (One Time)					   25.00

	Total Charge					$________



Method of Payment:


  [ ] Visa		Card Number:	_______________________________

  [ ] MasterCard	Expiration Date:___/___

		        Issuing Bank:	_______________________________

			Signature	_______________________________

  [ ] Check (not available for the Monthly Plan; please allow 2-3 weeks 
             for check clearance before your NetBox is activated)

Checks should be made payable to NetBox, Inc. US funds only drawn on
US banks. Wire transfers accepted with a US$15 handling charge.


Please fill out this form and return it to NetBox at:
Facsimile: 1-415-324-0998

Snail Mail:     NetBox, Inc.
                483 Channing Avenue
                Palo Alto, CA 94301 USA

Or call us at 1-800-9-NetBox (1-800-963-8269; 1-415-961-4880 from 
outside the US) to sign up or have any questions.