InstaNet Online Registration Request

Subscriber Information

Company Name, If Applicable

First Name Middle Inital Last Name

Address 1

Address 2

Address 3

City State/Province Zip Code

Phone Number Fax Number

Alternate E-Mail Address

Where did you hear about InstaNet Internet?

Special Offer Number (if any)?

Which Level of Service is for you?

Setup Fee Option?
- I will pay a one month setup fee.
- I will pay 3 months in advance.

InstaNet's Internet Information

Login Name

Make three choices for your InstaNet login name. You will be assigned the first one not yet in use!

Your login name should be at least three characters long and no longer than eight, and must begin with a letter.

Login Name:
Login Choice 1
Login Choice 2
Login Choice 3
Password Choice

Payment Information

InstaNet Internet charges $29.95 a month for standard Personal dial-in services.
This includes:

Payment Schedule -Service is prepaid each month, and additional charges are calculated and charged at the end of each month. Each account requires a one month additional setup fee. The setup fee is waived if the first three months are paid in advance.

To pay by Credit Card, fill out and fax us our Membership Application.
To pay by Checking Account Debit, fill out and fax us our Membership Application.
You have 7 days to make your first payment by check to:

Instant Internet Corp.
6355 Topanga Canyon Blvd
Suite 513
Woodland Hills, CA 91367
Fax to: (818) 888-0513

- I Agree To the Subscriber Terms Agreement
- I Do Not Agree, I Will Not Accept The Subscriber Terms Agreement

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