Name:
Address:
City:
State:
Zip:
Day Phone:
Night Phone:
Desired Account # (usually your 10-digit phone number):
Desired Passcode (must be all numbers):
Re-enter password for verification:
What Service Plan would you like? Please note that if
you select any of the limited time plans, you will be allowed 3 hours per
month. Additional minutes cost 10 cents each.
Email only -- your own mailbox ($8.95/mo.)
Email & Usenet -- your own mailbox ($11.95/mo.)
Email only -- mailbox on our server ($11.95/mo.)
Email & Usenet -- mailbox on our server ($14.95/mo.)
Web only ($8.95/mo.)
Web & Usenet ($11.95/mo.)
Email & Web -- your own mailbox ($11.95/mo.)
Email, Web and Usenet -- your own mailbox ($14.95/mo.)
Email & Web -- box on our server ($14.95/mo.)
Email, Web, and Usenet -- mailbox on our server ($17.95/mo.)
Email Only -- your own mailbox ($23.95)
Email Only, unlimited time -- box on our server ($26.95)
Email & Web, unlimited time -- your own mailbox ($26.95/mo.)
Email, Web, and Usenet, unlimited time, your own mailbox ($29.95)
Email & Web, unlimited time -- mailbox on our server ($29.95/mo.)
Email, Web, and Usenet, unlimited time, mailbox on our server ($32.95/mo.)
Check here if you want toll-free access for 10 cents per minute.
Please be aware that prices quoted here are monthly service fees, with
the first month billed in advance when you sign up for service. Charges for
minutes used over the allowed time for limited time plans are billed
following the month the minutes are used. Unused minutes may not be carried
over to the next month. You may cancel service at any time and you will
only be charged for service and overtime minutes used in the current 30-day
billing cycle.
Although we provide service on a month-to-month basis, we ask that you give
yourself sufficient time to get used to the service once you sign up. Cancellations
submitted prior to three weeks after the date of initial signup will be subject
to a $20 administrative fee.
POP Email Server Information
Fill in the POP Server Address and POP Password boxes below only if you
wish to use voice email with a mailbox provided by your own ISP (Internet
Service Provider). Most ISPs that offer standard internet access will allow
POP access to your mailbox, and will work with our system. Yahoo accounts
will work if POP access is enabled. (See the Yahoo Mail pages for more
information.) AOL and some free email accounts are not supported. If you
choose to use a mailbox on our server, fill in the Username below with the
name you would like to use for your email address. Your email address will
then be(chosen username)@philmore.com
Your POP Server Address (e.g. pop.philmore.com):
Your POP Username:
Your POP Password:
Re-enter your POP Password for verification:
Payment Information
Card Type
Visa
MasterCard
American Express
Discover
Card Number:
Name On Card:
Expiration Date:
Jan.
Feb.
Mar.
Apr.
May
Jun.
Jul.
Aug.
Sep.
Oct.
Nov.
Dec.
2003
2004
2005
2006
2007
2008
2009
Where did you hear about us?
Radio Ad
Newspaper Ad
TV Ad
Email Ad
Postal Mail Ad
Billboard/Poster Ad
Other (please specify below)
Once you sign up for service using this form, a customer
service representative will contact you within 24 hours to furnish you with
your account information, access telephone number, and answer any questions
you may have about our service.