PC Products and Services super-highway.net is your best value
in an Internet provider. Complete the following form and fax
it or mail it to PCPS.

Fax- 708-307-2386

super-highway.net c/o
PC Products and Services
1228 N Lake Street
Roselle IL 60172


Name:_______________________________________________________


Address:____________________________________________________


City, State, Zip:___________________________________________


Drivers Licence #:__________________________________________


Date of Birth:______________________________________________



Home Phone:___________________Work Phone:___________________



Data Phone:___________________Fax Phone:____________________



Login name:___________________Password:_____________________
Choose a login and a password for your access to the
Internet.

If you are under the age of 18, complete the following
section.


Parents:___________________________________________________



Address:____________________________________________________


City, State, Zip:___________________________________________

Type of account desired:

e-mail only @ $9.95 a month:______

Internet shell @ $14.95 a month:______

* PPP/SLIP @ $19.95 a month:_______
*This is the type of account that most users will want for
easy access to all parts of the Internet and convenient set
up and operation on their personal computer.

My computer is IBM_____ MAC_____ AMIGA______ UNIX_____
Payment type:

CASH____ VISA____ MASTERCARD____ AMEX____ CHECK____


CARD# _____________________________________________________


Expiration date:___________________________________________


*Auto-deduction from my credit card:________________________


Signature:__________________________________________________


Name as it appears on the charge card:

____________________________________________________________


PRE-PAY: 1 month____ 3 months____ 6 months:____ 1 year____

*I agree to let PC Products and Services debit my credit card
for the monthly fee for their services until I cancel the
service. Cancellation must be in writing 15 business days
prior to the billing date.

I agree to follow the rules of PC Products and Services Inc.
and the rules and laws of the Internet. We at PC Products and
Services have the right to:

1) Monitor the user e-mail and activities.
2) To cancel the service at any time.

I agree that my account is mine and I will be responsible for
all actions regarding it. It will be my responsibility to keep
my account secure, including my password.

The account is for my personal use only. I may use only one
modem line at a time. I will not loan my personal account to
others. I may not connect a BBS system or any other system
used by multiple persons without the written consent of PC
Products and Services.

You may not transmit unsolicited advertising through mass
electronic mail and Usenets, but posts made to the Usenets
are encouraged.

I am aware that portions of the Internet may contain things
that I may find offensive and I realize that PC Products and
Services does not control the content.
I have read all of the preceding text or have had it
explained to me and I agree to the terms.


Signed:_______________________________________________


Print name:___________________________________________


Date signed:__________________________________________