114 East Main Street
Panora, IA 50216
641-755-2424
panora@netins.net

Internet Registration Form
Type of Account: Individual Business
Name: ____________________________________
Organization ____________________________________
Address ____________________________________
City: __________________________________State __________ Zip _____________
Home Telephone (______) ___________________Work Telephone: (______)_________________
Preferred Username: ____________________________________ (15 Characters or less)
Social Security # ____________________________________
Mother's Maiden Name: ____________________________________(For password Security)
Date of Birth: ________/_________/_________
  Registration cannot be processed if the above is not filled out completely

Packages:  Check all services for which you are applying
Local calling area access - $ 19.95 per month
800 Number Access to netINS (Portable Internet) - $ 0.08 per minute
800 Number Access monthly fee - $ 5.00 per month
Free Additional Email Accounts
You can choose to have up to 4 additional email accounts at no additional charge. You are not required to use any additional usernames. Usernames need to be 15 characters or less.
   
1st additional email address username _________________ REAL name________________________________
2nd additional email address username _________________ REAL name________________________________
3rd additional email address username _________________ REAL name________________________________
4th additional email address username _________________ REAL name________________________________
   

Please indicate system type: WIN 3.1 and Windows 95 not supported

Windows 98SE/2000/ME Windows XP Web TV Macintosh

A signature is REQUIRED to process your order. Your signature below indicates acceptance of the billing terms and the netINS " Dialup Terms and Conditions" (below).
Customer Signature__________________________________ Date ____/______/______   
INTERNAL USE ONLY Customer No: ________ - _________ - _________
   

Return to:
Panora Telco
PO Box 189
Panora, IA 50216
FAX: 641-755-2425

 

Terms And Conditions

1. By signing this registration form and agreement, you (customer) agree to the following terms and conditions of the service described below.

2. These services are provided by netINS, 4201 Corporate Drive, West Des Moines,IA, 50266-5906.

3. Telephone technical support is available upon activation of your account.

4. All charges will be billed on your approved credit card as described on the the DIALUP REGISTRATION FORM. If for any reason a posting to your credit card is not accepted, your service may be discontinued. An additional registration fee, as well as re-establishment of valid credit, will be required to re-establish service.

5. INS make no express or implied warranty of any kind. There is no express or implied warranty of merchantability or fitness for a particular purpose for the services to be provided by netINS. netINS makes no attempt to verify accurate receipt of any message and is not responsible for any loss of data resulting from delays, nondeliveries, incorrect deliveries or service interruptions, including those caused by the negligence, errors, or omissions of netINS, nor for consequential damages regardless of their cause.

6. Customer agrees to comply with the terms governing use of the netINS network, as they may change from time to time. Any changes to the terms governing use of the netINS network will be posted as warranted on the netINS computer system. http://netINS.net/policy/

7. This agreement shall be governed by and construed in accordance with the laws of the state of Iowa applicable to contracts to be performed entirely within the state.

8. Either party may terminate this agreement at any given time by giving written notice. Such notice is effective when given. Customer is obligated to pay for service through the termination date, as detailed on the final invoice.

9. By accessing and using the netINS computer system, user is consenting to system monitoring for law enforcement and other purposes. Unauthorized use of, or access to, this computer system may subject users to criminal prosecution and penalties. User agrees to indemnify netINS against liability for any and all use of user's account.