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Application Form
Complete your details to open an Internet Access Account
This form requires you to be online to send it. If you are reading this offline (or on a CD) you should print out the non-forms version and post it to us.
Once you have sent this form, post your cheque/PO for either £129 or £28.25, payable to "Wirenet", together with the a completed Standing Order Mandate for monthly payments, to:
- Wirenet Amiga Internet
- 39 Larch Avenue
- Penketh
- Warrington
- WA5 2AZ
Your startup pack will be mailed out within two working days of receiving your payment.
| IMPORTANT: | When printing out this form, please ensure that the Standing Order Mandate appears on a single plage. If it is split across two pages, the bank will not accept it. |
Standing Order Mandate
To the Manager .................................................... bank Address .................................................... .................................................... Sort code: .............. Account number: .................. Account name: .................................................... Please pay the sum of �14.25 into the account below on the 1st/15th* of each month, beginning with the month of ........... Sort code: 20-91-48 Account number: 70162094 Account name: Wirenet Signature: .................................. Date: .................................. Telephone: ..................................* The standing order must be paid on the date soonest before the renewal is due. i.e if you subscribe before the 15th, then select the 1st. If you subscribe after the 15th, select the 15th. Your subscription renewal date remains on monthly intervals from the date the account is opened.
This page was last updated on Wednesday 03 November 1999.