On-Line Sign-Up Form

Thank you for choosing JVLNET!
>>> CLICK HERE IF YOU PREFER USING OUR SECURE SERVER SIGN-UP FORM <<<

Your account will be activated within 24 hours only if you include proper credit card information, or have a pre-approved business account. After you have submitted the form, you will be guided to the required setup information. If you have any questions please call our 24-hour support staff at 1-888-758-8750.

Which local JVLNET access city will you be dialing in to?
Janesville Madison Wisconsin Dells
Baraboo Portage Sharon
Reedsburg Fort Atkinson Beloit
Mauston Evansville Rockford
No Dial-Up Access Needed
New JVLNET Account

Change Existing JVLNET Account

Confirm Phone Order

Name:
Address:
City: State: Zip:
Contact:
Phone (Home):

Phone (Work):
Fax Number:

Modem Phone:
Customer Information for Internet Access Personal Plans:
Unlimited Single-User Personal Plan - 56K and 64K ISDN same low price 
Full Internet Access + E-Mail address + On Line News & Chat Services + 5MB Personal Homepage Storage 		$20/Month + Tax
Additional Family Members , or Multi-2 User accounts for bonded 128K ISDN 
 Full access with separate Username or same Username can log in twice, your choice.		 $10/Month + Tax
Additional E-Mail Address or E-Mail Only Account 
Additional sign-up Customer Information Sheet for each additional user		 $5/Month + Tax
Unlimited Single-User Madison Area or Group Rate Plan
Approved JVLNET Group: 		$15/Month + Tax
Teacher & Post High School Student
Full Internet Access + E-Mail address + On Line News & Chat Services + 5MB Personal Homepage Storage
Name of School:     Level: 		$120/Year + $15 Setup + Tax
[] Web TV    [] Sega Saturn Netlink 
For Internet access without using a computer.  Web TV (or Sega)  module is required to interface with TV . 		$120/Year + $15 Setup + Tax
Unlimited Single-User Preferred Plan
Same as Personal Plan + 2MB Ram + Extended Session and No Time Outs + More. 		$50/Month + Tax
Limited 30 Hour Per Month Plan
Same as Personal Plan - Limited to 30 hours per month use.  Automatic Credit Card Deduction Only. 		$10/Month + Tax
E-mail Forward - No dial-up access. $20/Year + Tax
Domain Registration, 50 MB Web Space and 5 E-Mails 
WWW. .   [] Register New    []Modify Existing 		$20/Month + $30 Setup

Customer Information for Internet Access Business Plans:

Unlimited Multi-User Business Plan
5 Full Access plans, 5 E-Mail Addresses, 50 MB Webpage Storage, Design &  posting of 1 starter page. 		$50/Month + $50 Setup
Personal Sub Domain [anyname.jvlnet.com]
http:// .jvlnet.com 		$5/Month + Tax
Username:
One public word used for login and e-mail. All lower case. No spaces, no punctuation. 12 characters maximum. Use the first initial of your first name followed by your last name.

(Joe Kerman's Login ID will be jkerman).
Username:
2nd Choice:
3rd Choice:
Password:
A private identifier used at login.  JVLNET will automatically assign you a password.  
If you are using this form for modification of your account, please continue to utilize your existing password.
BILLING:
You must include a valid MasterCard, Visa or Discover credit card to complete your on-line registration (skip only if you are requesting we mail you a sign-up application). Please note that JVLNET will be charging your credit card for the FIRST THREE MONTHS of access to start your subscription to JVLNET. THERE ARE NO REFUNDS.
Credit Card Type: MasterCard          Visa          Discover
Credit Card Number:
Expiration Date:    /   
Name on Card:
Future Billing Method:
After initial three months, I would like to be billed:  - (must select one): 
Driver's License Number:
To protect and secure your account
Computer Information:
Type of Computer:
Your current e-mail address:

How were you referred to JVLNET?:

by a friend (insert name)
by JVLNET user (insert name or email address)
Yellow Pages (insert name of phone book)
Newspaper Ad (insert name of newspaper)
Coupon in Mail (insert coupon number and source)
Radio ad (insert city and station)
Billboard (insert location)
Former JVLNET user (insert previous username)
Other (please specify)
Name of Person Completing this Form:

Special Instructions:

"I have read, understand, and agree to JVLNET's Terms and Conditions .
I wish to become a subscriber to JVLNET. I understand there are no refunds."

I Accept
I Decline, please send a JVLNET Sign-Up Kit in the mail

Notice: By checking "I Accept" above and clicking "Submit", you agree to the posted JVLNET Terms and Conditions .  You are also requesting a dial-in account for Internet access through JVLNET and give JVLNET permission to automatically charge your credit card for the first three months, and then periodically, as selected above and understand there are no refunds for any reason. You will be mailed a JVLNET Welcome Kit which includes the specific information you will need to access JVLNET.

Please contact Customer Service if you have any questions regarding this transaction.

For your convenience your account will automatically be renewed, unless you inform us otherwise.

Press Submit and send your information to JVLNET

Once you press Submit - you will have information to get on-line with JVLNET.

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