INTERNET ACCOUNT APPLICATION

Mt Angel Telephone Company


Complete all information requested below and return to :
Mt. Angel Telephone Company, 155 N Garfield St., PO Box 200, Mt. Angel, OR 97362
Phone 503-.845-2291 Fax 503-845-6599
If you have any questions about this application please call our office.


Account Information
Contact Name
 
Billing Name
 
Street Address
 
Mailing Address
 
City
 
City
 
State
 
Zip
 
State
 
Zip
 
Phone
 
Phone
 
E-Mail Login Name Selection
(This in not a password, you will be issued a password to access the system)
Login names are for individual mailboxes and must be no longer than seven lower-case alphanumeric characters.
Your E-Mail login name will read: "username@mtangel.net"
Login name (preferred)   (second choice)  
Additional mailboxes are available for $5.00 per month
Additional mail boxes (if applicable)
Login name (preferred)   (second choice)  
 
Preferred Login Password
 
System Information
In order to set up your account, we need to know :
Make and Model of your PC  
What operating system are you running and what version is it?  
 
What is the make, model & speed of your modem you will be using to connect to our service?
 
Charges to Users
Unlimited Package
$19.95 per month
Unlimited usage
Installation Charges $15.00 charge per account and $10.00 service order charge
I AGREE TO THE TERMS AND CONDITIONS LISTED ON THE CONTRACT.
User's Full Name (please print)
 
User's Signature:
 
Date