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Residential Dial Up - Subscription Form

Residential Dial Up Subscription Form
Sign up and be ready to go in 4 easy steps!

There is no obligation in signing up. If you wish to terminate your account anytime during your trial, please give accounting a call at (905)624-8566 five days before your free trial period expires.

Please provide us with your information
Name:
First:	Middle: Last:
Company:	Contact eMail:
Address:
Street:
City:	State: Zip Code:
Country:
Phone:
Home:	( ) ext.
Business:	( ) ext.

Please choose payment type:

Credit Card

Number:

Exp. date:

Billing address ZIP:

Please select your level of service

Online Sign 45 Hours $9.99 First Month Free, 0 setup, 9.99 monthly
Online Subs. Unlimited $14.99 First Month's Free, 0 setup, 14.99 monthly
Billing period:

Please choose Names & Passwords

Dial Up Account:

User Name: (ex. jsmith)

Password: (ex. mysecret)

eMail Account: (Optional email account @ica.net)

eMail Address: (ex. jsmith@ica.net)

Password: (ex. mysecret)

Real name for eMail accounts: (ex. John Smith)

4 additional eMail accounts are included with this plan. You may configure these eMails by accessing Online Customer Support with the password you enter below.

Online Customer Support:

Password: (ex. mysecret)

Re-enter Password: (ex. mysecret)

Thank You!

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