Wireless Internet Access
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Name:
Street Address:
City:
State:
Zip
Day Phone:
Evening Phone:
Email Account(s):
(Email Account 1)
Name:
Email:
@upperspace.net
Username:
Password:
(Email Account 2)
Email:
@upperspace.net
Username:
Password:
(Email Account 3)
Name:
Email:
@upperspace.net
Username:
Password:
What Wireless Package Would You Like?
Basic Wireless Service 384kbs ($39.95 per month)
Standard Wireless Service 768kbs ($59.95 per month)
Premium Wireless Service 1536kbs ($79.95 per month)
Choose your Options:
Add a dialup account ($10 per month)
Lease Wireless Equipment from Upperspace ($15 per month)
50 MB of personal web page space ($0 per month - $15 setup fee)
Payment Method:
Cash
Check
Credit Card
Visa
MasterCard
Discover
American Express
Credit Card Number:
Exp_Date:
Name as it Appears on the Card:
Agreement: By clicking below you fully agree to Upperspace’s Wireless Internet Terms of Service. If paying by credit card, I authorize Upperspace to automatically charge my card for the chosen service(s), until further notice from me.
I Agree Date: 11/21/2008
