Thank you for choosing pcOnline! Applications will be reviewed and processed generally within one business day. You will be contacted when your account has been created and a temporary password assigned.

Account Information

Name:
Company Name:
Address:
City:	State:
ZIP:
Daytime phone:
Evening phone:
How did you learn about pcOnline?

Username Information
Usernames must start with a letter, be at least 3 characters, and no more than 8 characters. Remember: the whole Internet will identify you with this username!

First choice:
Second choice:

Account Selection
Now, select the Connect Plan of your choice.

Connect Plus	$18.95 per month, unmetered
Static Connect	$29.95 per month, unmetered
Dedicated Connect	$99.95 per month, unmetered
Mail Connect	$5.95 per month, unmetered
Web Connect	$55.00 per month, unmetered
256K DSL - 1 Static IP Address	$24.95 per month
256K DSL - 5 Static IP Addresses	$34.95 per month
256K DSL - 13 Static IP Addresses	$54.95 per month
512K DSL - 1 Static IP Address	$49.95 per month
512K DSL - 5 Static IP Addresses	$69.95 per month
512K DSL - 13 Static IP Addresses	$89.95 per month
64K ISDN	$24.95 per month, 200 Hours
128K ISDN	$45.00 per month, 200 Hours
64K ISDN Routed	$45.00 per month, 200 Hours
128K ISDN Routed	$65.00 per month, 200 Hours

Billing Information
pcOnline accepts automatic payments in the form of VISA, MasterCard, Discover, or American Express. We also accept local checks if you choose to be billed. You can also choose the frequency of your automatic payment or bill (monthly, quarterly, semiannually, or annually).

Please choose how frequently you wish to make a payment or be billed:

Monthly (every month) Quarterly (every three months)

Finally, choose your form of payment:

VISA MasterCard Discover American Express Personal Check

By completing the following, you are authorizing pcOnline, Inc. to bill your credit card. Credit Card holder: Account number: Expiration date:

Questions or Comments?