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Subscription Form


Use this form to apply for a Cyberverse account. After completing the form, press the Subscribe button at the bottom of the page. Contact a Cyberverse representative at (310) 643-3783 if you are interested in a business account or need more information about available services.



NOTE! This will not AUTOMATIALLY create an account! All account information is verified by Cyberverse staff members BEFORE the account is activated.


Current E-mail address

If you can receive e-mail already on another system, please enter that address here. If we need more information before starting your Cyberverse account, we will attempt to contact you here first.


Who Are You?

Name:

Address:

Telephone Numbers:
- Day
- Night

Where did you hear about Cyberverse?


Billing Info

Please check one of the following indicating your method of payment:
Mastercard
Visa
American Express

Credit card number: Expiration (mm-yy):

Cardholder's name, as it appears on the card:


Account Info

Several different personal account options are available at Cyberverse. Please read the Services and Pricing list if you have not already.

Subscription plan:

Please enter the username you would like to use at Cyberverse. It may consist of 3 to 8 lowercase letters or numbers, but must start with a letter. Usernames must be unique among all subscribers.

Username:



We welcome your comments and questions.
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