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Action Internet Access Application

*Indicates Required Information

User Info:

*Name:

*Street Address:

*City:

*State:

*Zip Code:

*Phone Number:

Business Home

Phone Number:

Fax Work

Payment Info:

*Payment Via:

Credit Card OR Sending Check

If Credit Card fill Out Info Below:

Name As Appears on Card:

Credit Card #:

Must be a Visa or Mastercard.

Expiration Date:

Example: 12/01

*Type of Account:

	Dial-Up	ISDN 64K	ISDN 128K
3 Month	$59.85	$75.00	$150.00
6 Month	$119.70	$140.00	$280.00
1 Year	$219.45	$260.00	$520.00

Between the 11th and 22nd of the month you will be charged for only half of the current month. After the 22nd your payment will go for the next month.

Account Info:

Your account and Email will be identified by your User Name. Your User Name cannot contain a space or special characters and must be no longer than 8 characters. Please list two (2) possible User Names in the event the first one is already assigned. Use only lowercase letters. (Ex. jdoe)

*First Request for Username:

8 Char limit

*Second Request:

8 Char limit

Your Password must be at least 6 characters long, but no longer then 10 characters. One of the characters in your password must be a number.
Allowing another individual to use your Password is strictly forbidden as such actions pose security and legal problems and may result in cancellation of your Account.

*Password

(6 to 10 chars with at least one #)

*ReType Password:

With your account you are allowed to have a second e-mail account. If you would like to setup a second e-mail account at this time please fill in the information below. If not you can sign up this second e-mail account at any time using the link on Action's home page.

Second E-Mail Account Desired: Yes No

If yes fill out info below

First Request for Second
E-Mail Username:

8 Char limit

Second Request for
Second E-Mail Username:

8 Char limit

Second E-Mail
Password:

(6 to 10 chars with at least one #)

Re-type Second E-Mail Password:

Your Computer Info:

*Processor:

*Operating System:

*RAM:

*Modem Speed:

Kbps

Software:*

Action provides software for you computer. This software is sent out after we have received this application and payment. The software Action sends out is: Microsoft Internet Explorer 5.01. This software is multiple builds newer then the version included in Windows98 SE. The software runs on a 486dx66 or higher processor, with a minimum of 16MB of Ram and Windows 95 or higher. If you do not wish to receive this software please uncheck the box below.

I Require Software:

Comments:

Terms of Agreement:

Buy agreeing to this application you acknowledge that, as a member of the System, you understand that changes are made occasionally to the Terms and Conditions document as posted electronically on the System. Any questions related to the Terms and Conditions should be directed to a system administrator. As a subscriber, you agree that should you ever be unwilling to comply with any provision in the current Terms and Conditions document that you will immediately cease using the System and contact Action to request that your login account be closed. Any violation of the Terms and Conditions may result in the loss of System access privileges and/or legal action against the individual(s). All accounts include 60 days free Technical Support - $20 per incident thereafter.

Furthermore, you agree to the following cancellation procedure when/if you decide to terminate this agreement. This procedure does not apply if your account is terminated by Action for any reason.

1) No refund of setup fee(s)
2) Full refund of account fee if unable to connect within 1st 10 days.
3) Refund on 6 & 12 month contracts = 50% of remaining contract fees (based on calendar months)
4) All requests for Cancellation/Refund must be received in writing (email or USPS) with full account information (username, password, etc.)
5) All requests for Cancellation/Refund must be received on or before the 1st day of the month of Cancellation.

By clicking below you agree to the above terms and to the charges stated above for service. If you do not agree click here.

If you would like a current E-Mail account notified when your account is setup please fill out the space below:

Action Internet Access Application

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