Griswold
Cooperative Telephone Company Internet Registration Form
To apply for your netINS account, fill out this registration
form, sign it, and return to the Griswold Cooperative Telephone Company
business office. Email orders can not be accepted. PLEASE PRINT or TYPE.
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Name:____________________________________________________________ Organization:____________________________________________________ Address:_________________________________________________________ City: Home Telephone:
(____)___________ Work phone:
(____)___________ Preferred
Username: ____________________ (15 characters or less) $5 Administrative set-up fee for dial up accounts. Free installation for High Speed with installation
agreement. $99 installation fee for High Speed without
installation agreement. Registration cannot be processed if the above is
not filled out completely. |
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PACKAGES:
Check all services for which you
are applying: ð Local Dial Up Account Access - $25.00 per month ð 256K High Speed - $49.95
per month ð Call Waiting ð Call Forwarding ðThree Way Calling ð 512K High Speed - $69.95 per month ð 704K High Speed - $99.95
per month ð 800 Number Access to netINS
(Portable Internet) - $0.08 per minute ð netINS
E-mail Only (Requires Internet Connectivity) - $5.00
per month |
Free Additional Email Accounts
You can
choose to have up to 4 additional email accounts at no additional charge. You
are not required to use any additional usernames. Usernames need to be 15
characters or less. 1st
Additional username:__________________ REAL name:________________________ 3rd
Additional username:__________________ REAL name:________________________ Additional Email Boxes$5 /
month per mailbox. Usernames need to be
15 characters or less. 5th Additional username:__________________ REAL name:________________________ 6th
Additional username:__________________ REAL name:________________________ |
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Please
indicate system type: WIN 3.1
not supported ð Windows
95/98/2000/ME ð Windows XP
ð WebTV ð Macintosh |
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BILLING
INFORMATION Phone
number Internet service should be billed to: __________________ |
A signature is REQUIRED to process your order. Your signature below indicates acceptance of the
billing terms and the netINS “Dialup Terms and Conditions” (below).
Signature: ________________________________________ Date: ____/____/____
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netINS INTERNAL USE ONLY Customer No:_____ -______
- ________ |
Return to:
Griswold Cooperative
Telephone Company
607 Main
FAX: (712)778-2500
Terms and
Conditions
1. By signing
this registration form and agreement, you (customer) agree to the following
terms and conditions of the service described below.
2. These services are provided by netINS,
3. Telephone technical support is available upon activation of your account.
4. All charges will be billed on your monthly
telephone bill as described on the DIALUP REGISTRATION FORM.
5. INS makes no express or implied warranty of any kind. There is no express or
implied warranty of merchantability or fitness for a particular purpose for the
services to be provided by netINS. netINS makes no attempt to verify accurate
receipt of any message and is not responsible for any loss of data resulting
from delays, nondeliveries, incorrect deliveries or service interruptions, including
those caused by the negligence, errors, or omissions of netINS, nor for
consequential damages regardless of their cause.
6. Customer agrees to comply with the terms governing use of the netINS
network, as they may change from time to time. Any changes to the terms
governing use of the netINS network will be posted as warranted on the netINS
computer system.
7. This agreement shall be governed by and construed in accordance with the
laws of the state of
8. Either party may terminate this agreement at any given time by giving
written notice. Such notice is effective when given. Customer is obligated to
pay for service through the termination date, as detailed on the final invoice.
9. By accessing and using the netINS computer system, user is consenting to
system monitoring for law enforcement and other purposes. Unauthorized use of,
or access to, this computer system may subject users to criminal prosecution
and penalties. User agrees to indemnify netINS against liability for any and
all use of user's account.