FILL-OUT-FORM for NEW Subscriber
to www.MrINTER.NET

1007 Sepulveda Blvd., P.O.Box 242, Manhattan Beach, CA 90266-0242, USA.
Send me an INFO-Brochure:


I will subscribe for a UNLIMITED TIME  PPP-account with MrINTER.NET and recieve all programs I need to enjoy the WWW NET:

$ 19.50/mo. USERS ACCOUNT, NO sign-up or Registration Fees!
$ 50.00/mo. BUSINESS ACOUNT, Set-up starts $ 50
$ 75.00/mo. COMPANY ACCOUNT, Set-up starts $ 75
$100.00/mo.CORPORATION ACOUNT, Set-up starts $ 150

$ 50 Set-up for a standerized Home-page, with my Name & E-mail
$ 9.95/mo. for additional E-mail box
Call me for more INFO about my own DOMAINNAME and cost

Information about myself:
: E-mail Address, if applicable
http://: URL, if applicable
: Name & Title/Position
: Company Name
: Address
: City
: State/Province
: Zip/Postal Code
: Country
.: Phone & Fax Numbers

This is my NEW USER Name: (8 letter lower case)
This is my NEW PASSWORD: (6 upper case)

I will pay in the form of:

Credit Card #: Expiration Date:

Please call me back!

Short INFO about my Computer System:
I have/use a Macintosh IBM
I like/use the Browser NETSCAPE SUPER MOSAIC
I have/use a modem with 9.600KB/sec 14,400 28,800


Comments/Questions: (not necessary)

Please make a copy (print) of this form before it is sent!


For any URGENT Information call our HOTLINE USA 310 320-2226
or call (310) MrINTER.NET or send an E-mail to John
BACK to the Home-Page MINTER.NET

This form page is © copyright by John, February/6/96