Address_____________________________________________________________
City _____________________________ State _________ Zip _________________
Home Phone ________________________ Work Phone ______________________
I wish to make my first payment by:_____ Check (which I'm enclosing) ______ Credit card I understand that charges for subsequent months will be billed to my credit card each month for the basic service and any additional usage. I authorize this automatic billing by OnLine. OnLine's billing cycle follows the calendar month, with the basic service fee for each month charged at the beginning of the month along with additional usage fees from the prior month. I understand that I may cancel my account effective the end of that billing cycle.
If I have given my credit card number to OnLine, I understand that charges will be billed to my credit card each month for the basic service and any additional usage or service. I authorize this automatic billing by OnLine. OnLine's billing cycle follows the calendar month, with the basic service fee for each month charged at the beginning of the month along with additional usage fees from the prior month. I understand that I may cancel my account at any time effective the end of that billing cycle. If I am not satisfied and wish to cancel my account within the first 30 days of signing-up with OnLine, I may do so and receive a full refund of all money paid by returning all OnLine startup materials in good condition within those first 30 days and signing a statement certifying that I have kept no copies of any of the OnLine startup materials, either software or hardcopy. I understand that OnLine may change its prices from time to time, and that I will be provided with 15 days written or electronic mail notice of any such changes.
I agree to maintain my password as private and confidential information. I agree to use my OnLine account in a way that conforms with all applicable laws and regulations. I specifically agree not to make any attempt to gain unauthorized access to any other systems or networks. I understand that the information available through OnLine or interconnecting networks may not be accurate. I understand that the some of the information available through OnLine or interconnecting networks may be intended for adult audiences. I understand that internetworking communications are not secure, and may be subject to interception or loss. OnLine makes no warranties of any kind, either express, implied, or statutory concerning the data or information available through the OnLine network. I understand that the use of my OnLine account, and any data or information accessed using that account, will be completely at my own risk. I understand that the cumulative liability of OnLine for any and all claims relating to the services provided by OnLine, in contract, tort, or otherwise, shall not exceed the total amount of the basic service fees paid to OnLine for services within the prior year. I agree that OnLine shall have no liability for the services, data or information made available to me, including any liability for any consequential, indirect, special or incidental damages regardless of the success or effectiveness of other remedies. I understand that OnLine reserves the right to terminate my account at any time, for any reason, including, but not limited to, my failure to abide by the terms of this agreement or my failure to pay any fees or charges when due. I understand that violation of certain generally accepted guidelines on Internet usage, such as restrictions on mass e-mailings and mass advertising, or posting to inappropriate newsgroups, may cause severe operating difficulties for OnLine, and would be a likely cause for the termination of my account.
This agreement represents the complete agreement between OnLine, and myself, and supersedes any other written or oral agreement. The terms of this agreement may only be changed in writing and any changes must be signed by both OnLine and myself to be effective.
______________________________________ DATE: ________________________
(signature of applicant)