Application Form

Complete your details to open an Internet Access Account

Save this form, fill it out and post it with your cheque/PO for either £129 or £28.25, 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 application.

YOUR DETAILS

Name:

Current email:

Telephone:

Address:





INTERNET ACCESS ACCOUNT DETAILS

You will be allocated an internet address of the form userid@hostname.u-net.com
Please give your choice of userid and hostname:

Userid:     ______________   2 - 8  lower case characters - your "handle"


Hostname:   ______________   2 - 15 lower case characters - your computer's "handle"


2nd choice: ______________


Password:   ______________   6 - 8 lower case letters


The software and installer is usually posted out on disks or CDROM.
If you have an existing Internet connection with the means to transfer
downloaded files to your Amiga, you may opt to download the software instead.

If you have bought the NetConnect software pack you should use that instead
of the Wirenet software.

Please mark ONE of the following options:

__ Software on disks
__ Software on CD
__ Download software
__ Use NetConnect

Thank you - now please send this form, cheque/PO, and Standing Order Mandate, for a monthly subscription, to the address at the top of the page.

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:  ..................................