DialUp & *DSL HIGH SPEED
Internet Service Application
We accept Visa, Mastercard, Checks, Moneyorders.
We also offer either paying Monthley, Quarterly, Semi Annual, Annual.
Date:
First Name: Last Name:
Address: City:
State: Zip Code:
Telephone: Fax: *Must have a Qwest Phone line, if not must use the Stand Alone line.
Email Address: Internet Service Choice: Dial Up 256K Residential 1.5Mb Residential 1.5Mb Stand Alone
Payment Type: Visa Master Card Check Money Order Billing Method Monthley Quarterly Semi Annual Annual We will not ask for your Credit Card Information over the Web. You may provide that Information when you Activate Service Any Comments or Questions:
Copyright © 2002 River City Internet 1701 South Eisenhower Mason City, Iowa 50401 Toll Free 1.800.247.5988 Phone: 641.424.1511 Fax 641.423.7843