Northern Lights Internet Services Dial-Up Account Registration Form TO: FROM: J. C. Kilday Associates Name _______________________________ P.O. Box 1961 Portland, ME 04104 Address _______________________________ City,State,ZIP _______________________________ Home Telephone _______________________________ Northern Lights offers flat-rate 56K dial-up Internet access accounts. All accounts include a single Internet e-mail mailbox and a free home page on the Northern Lights web server (http://www.nlbbs.com). Northern Lights does NOT charge an account installation fee. And we assist you in setting up appropriate access software on your computer. Please indicate the desired type of account and initial duration by circling the appropriate price in the table below. The effective per-month cost decreases as the initial sign-up period increases. DURATION OF ACCESS Account Type: 3 Months 6 Months 12 Months ------------- -------- -------- --------- Standard Service Account $ 55 $105 $200 (Uses our Portland, Maine 56K phone lines.) National Service Account $ 60 $115 $220 (All 56K service, can include Portland, plus over 7000 locations nationwide. Your choice of 1 of 4 national networks) Please indicate your desired UserName below, up to 8 characters, no spaces. Examples: johndoe, jdoe, batman, etc. If you have a preference for a particular password please provide it also. Recommended passwords include both letters and numbers where the letters do not spell a word. If you do not provide a password, one will be assigned. UserName: ________________ (8 chars/max, all letters lower case) Password: _________________ (if left blank one will be assigned) If your service choice includes a national network, please carefully select it (see http://www.nlis.net/access.numbers.php) and enter your choice: ________. Computer OS (check 1): _ Windows 95/98/ME _ Windows XP/2000; _ Mac; _ Other Please return with your check in the amount circled in the table above and payable to J. C. Kilday Associates.
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