(RANGENET INTERNET SERVICES, INC.)

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RANGENET SIGN-UP APPLICATION
After submitting the application, We will set up your account and email you when complete. You can set your account up using information provided in our Support Center. We will also try to reach you by phone to assist you if neccessary.

Account Type	(Click The Drop Arrow For Options)
Full Name	(As It Appears On Your Checks, Please!)
Company
Contact Email
Billing Address	Street: City: State: ZIP:
Phone Numbers	Day: Evening:
System Info	Type: Modem Speed:
User Name & Password	Usernames Are Used to Identify you on rangenet, your email address will start off with this name, EX. dolphin@rangenet.com (here, dolphin is the username). Your Username must me 3 - 8 characters long no capital letters please!. Username: A Password keeps other people from being able to use your account, keep this secret, NEVER give it out! should be 6-8 characters long. Password:
Acceptance	Applicant (or guardian if applicant is a minor) agrees that the above information is accurate and true, and has read, understands, and agrees to the policies, limitations, and rules in the Rangenet Internet Services, Inc. Terms & Conditions. If applying for an account electronically, indicate acceptance by typing I AGREE in the signature box below. In lieu of a hand-written signature, applicant specifically agrees that use of RANGENET indicates acceptance of all terms and conditions acknowledged by a signature. Signature: Date:
Comments	Previous Internet Service Provider: How did you hear about RANGENET? Any other comments?:
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