INFOSERVE

New ADSL Account Signup Form

To open a new ADSL account with Infoserve please fill in the form below. Make sure you enter all the information in this form. Once your account application is processed our member service representative will contact you with further details.

Make sure you have read and agreed to our membership terms and policy statement before you proceed. If you have not read the agreement please review it now SERVICES

Your First and Last Name:

First name

Last name

Your Address:

Street address

Address (cont.)

City

Province

Postal code

Home Phone

Work Phone

Fax Number

Phone number for ADSL

How many phones/fax using this ADSL phone number?

Current E-mail address

Are you running:

Win95
Win98
WinME
WinNT
Win2000
WinXP

Have you installed a network card in the PC?

No
Yes

If you don't have a Network card do you want us to supply and install one? (Note - ADSL won't work without a network card)

No
Yes

Choose type of account you want to open:

Residential ADSL - First 12 months at $29.95/month then $34.95/month (You buy adsl modem from Infoserve)
Business ADSL 1.5mbps $65.00/month
Business ADSL 2.5mbps $99.00/month
Business ADSL 4.0mbps $165.00/month

Enter any comments below:

Street address
Address (cont.)
City
Province
Postal code
Home Phone
Work Phone
Fax Number
Phone number for ADSL
How many phones/fax using this ADSL phone number?
Current E-mail address