Sign Up for a Dialup Account

Please fill out the following form. If you do not provide a Fax number or Email address, your completed sign-up sheet will be mailed to your mailing address within one business week. Otherwise, we should respond to you within two working days.

Fields marked with the * are required. Billing information is required upon sign-up.

*Account type: Analog (up to 56k) dialup
ISDN dialup
*First name:
*Last name:
*Login name
(first choice):
2-8 characters
*Login name
(second choice):
2-8 characters
Company name:
*Billing address:
*City:
*State:
*Zip code:
Home phone:
*Daytime phone:
Fax number:
Email address:
*Billing type:
*Requested Package Dialup Package
Executive Partner
Executive Partner Plus
Professional Partner (without web hosting)
Professional Partner
Do you want 800 access?
(additional charges may apply)
Yes
No
Do you want Multi-Link access?
(additional charges apply)
Yes
No
If you are switching ISPs,
which one are you switching from?
How did you hear about us?
What sort of computer do you use?
What OS do you use?
What web browser do you use?
What email reader do you use?
What speed modem do you use?
Comments


 
© 2000-2006 Internet Partners, Inc.
1800 NW 167th Place Suite 160 - Beaverton, Oregon 97006-8132
+1 503 690 2700       FAX +1 503 690 9700