2600 Skymark Ave.
Building 9, Suite 201
Mississauga, Ontario
L4W 5B2
 Tel: 416-385-0459
Fax: 416-385-0469
Email: sales@echo-on.net

DEDICATED CONNECTION SIGN UP FORM

Company Name: __________________________________________


Company Address: __________________________________________
__________________________________________
City: __________________________________________
Postal Code: __________________________________________

Contact Name: __________________________________________
Contact Phone: ________________ Contact Fax: ________________


Preference Login Name Instructions
1st Choice
Login names can be from 3-8 character. All character must
be lower case. Valid character are any Alpha Numeric
Characters (a-z,0-9). Punctuation is Not allowed.
2nd Choice
3rd Choice
Password
2-16 Characters. No puntuation allowed

* This account will have access to modify web documents

* PLEASE LIST AT LEAST 2 CHOICES IN ORDER OF PREFERRENCE
Preference Domain Name Requesting
1st
2nd
3rd

Dedicated Account Price Structure


------ 64K ISDN ------ ------ 128K ISDN ------

56K Lite Regular Professional Lite Regular Professional
Initial Setup Fee $199.99 $599.99 $599.99 $599.99 $599.99 $599.99 $599.99
First Month $199.99 $249.99 $299.99 $349.99 $449.99 $499.99 $549.99
Each Additional Month $199.99 $249.99 $299.99 $349.99 $449.99 $499.99 $549.99

* Please Note: This account includes Domain Name Signup
_____________________ _______________________________________
Date Signature

Payment can be made via VISA, Mastercard, American Express or cheque. Please make all cheques payable to Echo Online Internet.