OnLine Image, Inc. Information Request Form

Information request or Sign up for new service.
Please call 535-4215 after requesting new service to get your machine set up or so we can send you software (if you need it).
Rates for Full Internet Dial-up Access - $20/month or $200/yr dial up
(wireless rates higher check here)

Please fill in all "required" fields

NAME: Required

COMPANY NAME:

ADDRESS LINE 1: Required

ADDRESS LINE 2:

CITY: Required

STATE/PROVINCE:

COUNTRY:

ZIP + 4: Required

PHONE (DAY): Required

PHONE (NITE): Required

E-MAIL ADDRESS: Required

If you wist to sign up for new service please fill in the following:

User ID desired Between 4 - 8 characters (1st choice): Required

User ID desired Between 4 - 8 characters (2nd choice): Required

Password desired MUST BE 8 CHARACTERS: Required
Use at least 3 special characters
(such as: % * & # ! 2 5 7) (no dictionary words)

What type of acces do you want (default INTERNET= normal account)

What Operating System do you use?

What modem speed do you have?

If you signed up for service, you will be billed by e-mail after you are connected. You will be contacted by one of our tech support personnel for setting up your computer

Please use the blank area below for any Questions or comments:

Please, Only Click ONCE to Submit The Form (Button Below)

Return to OnLine Image, Inc. Welcome Page

NAME: Required
COMPANY NAME:
ADDRESS LINE 1: Required
ADDRESS LINE 2:
CITY: Required
STATE/PROVINCE:
COUNTRY:
ZIP + 4: Required
PHONE (DAY): Required
PHONE (NITE): Required
E-MAIL ADDRESS: Required

User ID desired Between 4 - 8 characters (1st choice): Required
User ID desired Between 4 - 8 characters (2nd choice): Required
Password desired MUST BE 8 CHARACTERS: Required Use at least 3 special characters (such as: % * & # ! 2 5 7) (no dictionary words)