Access Order Form

Please fill in the form below, completely, and you can get online quickly!

If you don't have a browser that supports forms email us or call the number below.
Include INTERNET ACCESS in the subject line.

Filling in this form or sending us Email does not obligate you to anything!

Referal ID number...: Only needed if you were referred!
Your First Name......:
Your Last Name......:
Your Company........:
...................Address:
................................:
City: State: Zip: Canadian Province:
Your E-Mail Address: Valid Email only! Leave blank if you don't have one.
Your Phone Number..:
Your Fax Number.....:
What type of OS are you using?:
Windows 3.X
Windows 95
DOS only
OS/2
MAC
OTHER (Specify in comments)

How much a month are you paying now for internet access?
$0
$1-9
$10-15
$16-20
$21-30
$more

Desired Username
Desired Password
Where did you hear about this deal? (If Internet...where on the net)

Comments or questions:

*

After filling in all the information click on the SEND button, above, to send the info to us.
It could take about a minute to get the next page so please be patient...

Emory Computer Consultants

Email info@emory.com

(954) 722.7798

This page maintained by and Copyright (c) 1995--2002Emory Computer Consultants

We are not responsible for content of advertiser's sites listed above or below!

area codes