Izzy Dot Net - On-Line Application

Upon completion of the on-line form following, select SUBMIT to enter your application or RESET to clear the form and retry. We will add you to the Izzy subscriber list and provide you with an account within one business day or less.

Note: Some browsers (notably AOL's) don't handle forms correctly. Please follow up with an E-mail to support@izzy.net if you don't hear from us within 24 hours

Provide your name and select a logon ID

First Name
Last Name

Mother's Maiden Name

We ask for your mother's maiden name so that we can identify you as the proper account owner should you ever need to have your account password changed.

Preferred Logon ID
Alternate Logon ID

Eight characters maximum, letters and numbers only. If your preferred and alternate logon IDs are already taken we will assign you the preferred ID and add a 2 digit suffix. Call us at (734) 213-5710 if you are unable to log in to your account with either of your chosen IDs.

Mailing Address and Phone

Home
Business

Street Address
City
State
ZIP Code

Voice Phone
FAX

What operating environment(s) do you use?

DOS
Windows
Macintosh

Other(please specify)

Choose Your Preferred Account Type

Email
Shell
Single IP
Lan IP
UUCP

An Email account uses the full screen Pine mailer. The account has no access to any other Internet facilities.

Choose Your Preferred Connection Type

56Kbps pool
ISDN Adapter pool
Dedicated ISDN 64Kbps
Dedicated ISDN 128Kbps
Dedicated 56KB Leased Line

Would You Like to Order the Easy Internet CDROM?

Yes (For IP accounts under Windows 3.1 or Windows 95 only)
No

Additional Necessary Credit Information

Some people consider it risky to provide sensitive data over the Internet. If you don't want to provide this information electronically, we can contact you to get the needed information by phone. Simply check the "Call Me for Information" box following.

Call Me for Credit Card or Invoice Information
I've Provided the all the Information needed

If paying by company invoice:

Purchase Order Number

Are you currently an Internet user?

Yes
No

Provider Name

How would you describe yourself as an Internet user?

Novice
Intermediate
Advanced

Additional Comments, don't send credit card numbers!

Send (Submit) this application to Izzy Dot Net. We will set up your account within one business day from receipt.

(select to register) (select to clear the form)

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