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SUBSCRIBER REGISTRATION FORM
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ARInternet Corporation
8201 Corporate Drive * Suite 1100 * Landover, MD 20785
1-800-459-7175 * 301-459-7171 (voice) * 301-459-7174 (fax)
E-mail: [email protected] * WWW: http://www.ari.net
Subscriber Information:
Name __________________________________________________
Address __________________________________________________
__________________________________________________
__________________________________________________
Phone ___________(Day)___________ (Eve)_____________(Fax)
E-mail _________________ (if available)
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Requested Action:
O Send More Information
O Open Account O Preferred UserID _______________
(if available)
Type of Account:
O E-mail/News O Shell O SLIP O PPP
O Dedicated 28.8 O Frame Relay O ISDN
Payment:
O Monthly O Quarterly O Annually
* Pay by:
O Check (enclosed)
O Check (please bill me)
O Purchase Order
O Credit Card
O AMEX O Mastercard O VISA
Account Number: ___________________________
Expiration Date: ___________________________
Name on Card: ___________________________
** Mother's Maiden Name:____________________
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*** Gift Subscription: This subscription to ARInternet is a gift.
Please bill me but set up the account in the name of:
Name __________________________________________________
Address __________________________________________________
__________________________________________________
__________________________________________________
Type of Card: O Plain O Congratulations_____________
O Birthday O Holiday ___________________
Message: __________________________________________________
__________________________________________________
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* We require prepayment by credit card or check in order to set
up the account. The first bill for service will be prorated to
the end of the month, based on a 30-day month. Accounts opened
on or before the 15th of the month will be billed in advance for
the rest of the month. Accounts opened after the 15th will be
billed for the rest of the month and for the following month, in
advance.
** This information is used as verification of user
identification in the event of requests for password information,
account transactions, and so on. If another item of this nature
is preferred, please indicate this on the form and supply the
code word.
*** We will send a card to the gift recipient informing him or
her of the establishment of the account and the UserID and
Password, plus any message supplied on this form. Please select
the type of card to be sent from the options listed.