Printed Name ______________________________________________
City, State, Zip _____________________________________________
I request my "User Name" be: ____________________________ (no more than 8 characters in length).
I request my password be: _____________________
Enclosed is payment in the amount of $_____________ for the first month's service as shown on the Schedule. Make all checks payable to "VFR Digital"
I want my service fees (including any roaming charges I may incur) charged to my credit card. I hereby authorize VFR Digital to charge my service fees to my credit card each month. I understand that this charge will be posted automatically without any further authorization from me and will continue to be so charged until I notify VFR Internet, in writing, to the contrary. I also understand that I will not receive any invoice to confirm each such monthly charge unless I specifically so request, in writing.
Card No. __________________________________________
(MC, Visa, Am Ex, Discover)
Expiration Date: ______________
Name as it appears on Card: ______________________________________________
Computer info: _____ Windows 3.1
_____ Windows 95 _____ Windows 98
_____ Apple _____ iMac
Referred by: ______________________________________________
Mail to: VFR Internet, PO Box 1246, San Martin, CA 95046 Phone: 800-899-4125 Fax: 408-681-1528