ECHOWEB Business Account Application

P.O. Box 1091-1196
Grants Pass, OR 97528
www.echoweb.net
info@echoweb.net

phone: 541-471-0457
fax: 541-471-0530
toll free: 1-888-471-0457
(from outside local calling area)

BUSINESS ACCOUNT APPLICATION To start a business Internet account with EchoWeb, just fill out the application below and either mail it to us
at the address above, or drop it by:
EchoWeb, 543 NE 'E' St.,
Suite #106, Grants Pass
Date of Application: ______________________________ [Rec'd: _________________________]

BUSINESS ACCOUNT APPLICATION for [___]GRANTSPASS.NET or [___]SO-OREGON.NET

Business Account Name Requested: ______________________________ (Up to 8 characters-lower case)

Account Password: ________________________________________ (Up to 8 characters-case sensitive)

Business Name: _____________________________________________________________________

Address: ___________________________________________________________________________

____________________________________________________________________________

Contact Person: __________________ Phone #: _______________ Ext: _____ Fax #: _______________

BILLING & PAYMENT PREFERENCES

Website only: Subscribing: [ ]Quarterly $60.00 [ ]Semi-annually $120.00 [ ]Yearly $240.00

Website and primary access account: Subscribing: [ ]Quarterly $90.00 [ ]Semi-annually $180.00 [ ] Yearly $360.00
Additional access accounts charged to and paid by the same business account - Quantity: _____
[ ]Quarterly $45.00 ea___ [ ]Semi-annually $90.00 ea___ [ ]Yearly $180.00 ea___
(Enclose personal account applications for each additional access account.)
Billing Options: (All bills due on the first of the month for the following service period.)
[ ]Bill via E-mail account [ ]Bill via postal service (add $1.00 per billing cycle chosen)
[ ]Bill via credit card - (We accept MasterCard and Visa)
Name on Account: ________________________________________

Card #: ________________________________________ Expiration Date: _________________

Signature of cardholder: ___________________________________________________________
Please enclose first payment and $20.00 Activation fee with application.

Additional Services [ ] On-site software set-up for internet connection on client machine - $20/hr. ea. - Quantity: _____

[ ] Initial publication of your front page - $125 one-time charge. (Please include text and logo or graphic.)

[ ] Initial publication of your site, up to six pages - $500.00
(Text and logo or graphic, supplied by client. Form and outline consulting included.)

[ ] Graphic Design - $45/hr.

PRIMARY ACCESS ACCOUNT EQUIPMENT INFORMATION What type of PC do you have? IBM/compatible with [ ]NT [ ]Win95 [ ]Win3.1
Mac/compatible with OS [ ]8 [ ]7.6 [ ]7.5 [ ]7.1
Please describe your modem:
Brand: ______________________________ Model: ______________________________
Type: [ ]Internal [ ]External Speed: [ ]67K [ ]56K [ ]33.6 [ ]28.8 [ ]14.4

Do you have previously installed INTERNET software? [ ]Yes [ ]No
Do you have a dedicated phone line for your computer? [ ]Yes [ ]No
Do you have call waiting? [ ]Yes [ ]No Do you have a cordless phone? [ ]Yes [ ]No

Subscription Agreement
I HAVE READ, AND AGREE TO THE SUBSCRIPTION CONDITIONS AVAILABLE AT
www.echoweb.net/agreement.htm AND I WISH TO OPEN AN ACCOUNT WITH ECHOWEB, LLC.
IF I AM UNDER 18, MY LEGAL GUARDIAN HAS SIGNED BELOW.

SIGNATURE: ________________________________________ Date: ____________________