iMetWeb.Net-Marysville/Richwood
SUBSCRIPTION FORM

Please complete the information below and sign the form. Mail it to iMetWeb.Net at P.O. Box 226, Marysville,Ohio 43040. Maintain a copy for your records. Upon receipt we will process the information and notify you with your account access number(s). Subscription form must be signed for access. Persons age 18 & under must have a Parent or Guardian's signature. DO NOT SEND CASH.
                                                                          ACCOUNT INFORMATION

Last Name:_____________________________________First Name______________________________
Address:________________________________________________________________________
City:___________________________________________State:____________Zip:_____________
Home Phone:____________________________________Work Phone:______________________

User names and passwords should be 3-12 characters long.  You may use numbers and letters together.  Letters however should
be lowercase.  Example---joe415doc or flower.  (Mac's cannot have numbers in password)
User/E-mail Name:________________________________Password:______________________________
Additional E-mail Account: $5.00 per each additional e-mail per month
2nd User/E-mail:____________________________________Password:_____________________________
3rd User/E-mail:____________________________________Password:_____________________________

SUBSCRIPTION: (Please Circle One)
                                                   INTERNET                              JT Subscribers rate
Monthly*              $19.95                                       $17.95
               3 months               $55.66 ($18.55)                         $52.50 ($17.50)
                 6 months               $110.12 ($18.35)                       $103.50 ($17.25)
                1 year                   $217.85 ($18.15)                       $204.00 ($17.00)

*E-mail address other than iMetWeb.Net for contact/billing_______________________________

SYSTEM TYPE:
Windows ME_____Windows 2000____Windows XP_____Windows Vista______Mac OS____WebTV_____Other______

PAYMENT/BILLING METHOD:
Visa______  Mastercard_______  Check________  Cash_______
Issued To:__________________________________________________
Card # : ______________________________________________Expiration Date:______________

I certify that I am the owner and /or authorized user of the credit card. I authorize iMetWeb.Net  to charge the above credit card for my monthly subscription. This agreement, providing unrestricted access, will remain in force and charges will continue for services until I notify iMetWeb.Net in writing or by E-mail requesting this service be discontinued. Prepaid subscription cancellations will be subject to the current monthly rate for actual months used. Subscription cancellations must be received 5 days prior month end. iMetWeb.Net is not responsible for service interruptions or downtime caused by users or service providers. I also agree to iMetWeb.Net's "Terms and Conditions" which can be found at www.imetweb.net

Signature:________________________________________________Date:______________Amount:______________

For information about Internet, E-mail, or Business Connections call iMetWeb.Net at (937) 644-9111 ext. 160, 1-888-282-9111, E-mail- support@imetweb.net . You can also fax your subscription to (937) 644-2133.