Printable On-Line Subscription Form

P.O. BOX 565 * BELOIT * KS * 67420 PHONE: (785) 738-2218 FAX: (785) 738-2185

USER SERVICE AGREEMENT
Please complete and return this signed Service Agreement with payment for set up fee and first month’s subscription. Please print clearly. 

GENERAL INFORMATION:

Full Name (Users or Company Contact name):  ____________________________________________________________
Company Name (if applicable):  ____________________________________________________________
Requested Username (or one will be assigned)  ____________________________________________________________
Street Address: _______________________________ ____________________________________P.O. Box: ______
City: _______________________________________ State: ___________________________ Zip:_________________
Home Phone:  _______________________________ Business Phone:  _________________________________
Billing Address if different from above:  Address: _________________________________
City: _________________________________ State: ____________Zip: __________________

ACCOUNT INFORMATION:

All accounts are provided with free access software, or if preferred, commercial software is available. Windows 98 + compatible PC Minimum system requirements: Pentium 200MHz, 32MB RAM, CD-ROM, TCP/P software (provided or available), and a working high quality modem. Macintosh system requirements: 68040 CPU or higher, System 9.1+ or higher, 16MB RAM, CD-ROM, TCP/IP software (provided or available), and a high quality working modem/ethernet.

ACCOUNT TYPE:

______$18.00 Residential Dial-up (Windows or Macintosh) 33.6 Kb modem connection -$18.00 per month plus $35.00 set up fee -50 HOURS of on-line time each month, 5 MB of Internet storage (including web pages and E-mail), -1 E-mail account, -Web, FTP and NEWS. One month free with pre-paid yearly subscription.

______$25.00 Residential Dial-up (Windows or Macintosh) 33.6 Kb modem connection -$25.00 per month plus $35.00 set up fee -"Un-Metered" Hours of on-line time each month, -5 MB of Internet storage* (including web pages and each E-mail), -Up to 5 E-mail accounts per household, -Web, FTP and NEWS. One month free with pre-paid yearly subscription.

______$25.00 Residential Dial-up (Windows or Macintosh) *56K modem connection -$25.00 per month plus $35.00 set up fee -56K access with "Un-Metered" Hours of on-line time each month, -5 MB of Internet storage* (including web pages and each E-mail), -Up to 5 E-mail accounts per household.  -Web, FTP and NEWS. One month free with pre-paid yearly subscription.

______Commercial Dial-up (Windows or Macintosh) *56Kb modem connection -$35.00 per month plus $35.00 set up fee, -56K access with "Un-Metered" Hours of on-line time each month, -Up to two (2) simultaneous connections, -5 MB of Internet storage* (including web pages and each E-mail), -Up to 5 E-mail accounts per business. -Web, FTP and NEWS. Options: $5.00/month – five (5) additional E-mail accounts, $5.00/month additional 5 MB Internet storage. One month free with pre-paid yearly subscription.

______Wireless IP Broadband (Windows or Macintosh) Always on connection -$49.00 per month plus $35.00 set up fee, -Member one-time Equipment purchase of $500.00 **$250.00 Special (**Call for latest pricing), Always on, full time Internet access to your Ethernet connection, (LAN or Computer). One active CPE (Customer Premise Equipment) device. 25MB of Internet Space, 5 POP3 E-mail accounts, Free Members Web site, 1 Wireless Access Installation. 1 month free service with pre-paid yearly Special Broadband Wireless subscription.$35.00 account setup fee for new NCKCN members. There is no account setup fee for existing NCKCN members. ** Special - 1/2 off equipment and installation. $250 for equipment and standard installation with 1-year pre-paid subscription. Sign-up fee waived. 

*56K access available in limited areas. *Please call, or visit our web site at www.nckcn.com.


Please Specify Operating System

Windows 98/98 Second Edition Windows ME Windows 2000  Windows XPWindows NT Mac WebTV


PAYMENT INFORMATION

Payment is expected by the 1st day of the month preceding service delivery. If payment is not received by the 5th of each month, access will be disabled. At that point NCKCN will continue to receive and store customer’s E-mail until payment is either made or 30 days pass. If no payment is received by the end of the month or if no other arrangements are made, all files maintained in storage will be deleted.

Billing will be done by E-mail on the 25th day of each month. This will be the only reminder users will receive.


SIGNATURE SECTION

By signing this USER SERVICE AGREEMENT, I acknowledge the above information is correct as of the date signed and that I am responsible for payment of this account. If representing a business or company, I certify I have the authority to enter into this agreement on behalf of the company or entity named. Furthermore, I have read and fully understand and agree to the Service Contract listed. I agree to inform NCKCN of any changes in the above information in a timely fashion.

Signature: ________________________________________________________

Date: ____________________________________________________________

 


NORTH CENTRAL KANSAS COMMUNITY NETWORK SERVICE CONTRACT

The North Central Kansas Community Network Co. (NCKCN) agrees to provide and User agrees to receive access to the NCKCN. Internet, telnet or dial-up service according to the following terms and conditions:

Your application may not be processed without payment and a signed Service Agreement. Upon Receipt of this application, NCKCN will send all required software (if applicable) and user information to get started.