Idial ISP - Internet provider, dialup, high speed internet access

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MAIL-IN SIGNUP FORM
(For Check or Money Order Payments)

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We accept signup and your payment via personal check or money order, however we are only able to accept payment by this method when paid in advance quarterly (every 3 months).

If you wish to signup for payment by check or money order, please print this page, fill in all the fields, and mail it along with your check or money order to the address noted at the bottom of the page. Every three months you will receive an invoice via email approximately 15-days in advance of your payment due date. Please make sure we receive your payment by the due date to avoid interruption in service. A $5.00 re-instatement fee may be required if services are interrupted due to non-payment. Please remember that this is a pre-pay only service and your check must clear the bank before service can be initiated.

Customer Information

Name:       _________________________________

Address:   _________________________________

City:         _________________________________

State, Zip:       _____________________________
Date: _____/_____/_____
Company Name: _____________________________

Daytime Phone #: ____________________________

Evening Phone #: ____________________________

Account Information

Choose a User Name: ________________________

Choose Another : ____________________________
(in case first choice isn't available)

Choose a Password: _________________________

The following is used as a security measure to allow
changes to account.
Security Word: ______________________________
(example: mother's maiden name)

Internet Package Choice   please check one

          $23.85/quarter - Standard 56K Dialup Access
          $29.85/quarter - High-Speed Dialup Access

Method of Payment   please check one

   Check (Payable to: Idial Internet)
   Money Order (Payable to: Idial Internet)

Mail Payment To:

    IDIAL.NET
    New Accounts
    P.O. 2939
    Coeur d'Alene, ID 83816