After completion of this form, you will be entered into a drawing for some cool free stuff!

Please enter your username

Please select your area code  and your prefix

Please select the phone number you most often dial into
when you use InstaNet Analog or ISDN
Please select a secondary phone number you alternatively or
occasionally dial into when you use InstaNet, if appropriate
e.g. home versus your office (optional)
Alternative phone number 1 Analog or ISDN
Alternative phone number 2 Analog or ISDN
Alternative phone number 3 Analog or ISDN
Alternative phone number 4 Analog or ISDN

Your modem's brand and model

Time(s) of day you normally dial in

Approximate number of hours you are online per day

Comments?

    Thank You!