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Personal Information
Name:
Address:
City:
State:
ZIP Code:
Daytime Phone Number:
Evening Phone Number:
Your Current E-mail Address (if any):
Account Information
User ID: Your username has to be 3 to 15 characters, and can only be in letters, numbers, dots and dashes. See Examples of User ID's. This username will also be part of your e-mail address. We ask for two choices in case your first is already in use. In the rare case that both of your choices are in use, we will let you know when we call.
1st Choice for UserID:	Write this down!!
2nd Choice for UserID:
Password: Your password is the way that you protect your account from use by other people. It should be 6-10 characters in length, and contain a mixture of upper and lower-case characters and/or numbers. Examples: `I8aBuG, Ou8aBUg2`. The two examples given are not good passwords though because anyone can see them now, so they are no longer "secret". You will be asked below to enter your password twice so it can be verified.
Password:	Write this down, too!!
Password: (Again)
Optional Information
These next few questions are optional so you don't have to answer them, but we sure would appreciate it if you did.
How did you here about ACC-NET?
Did a friend refer you? If so, what is their E-Mail address? (They will get a FREE month for telling you about us.)
You are now ready to submit your signup request. Please review all the information that you have entered to ensure that it is accurate. When you have done that, use the submit button below to submit your request. Submitting this request implies full agreement to ACC-NET Terms and Conditions. By submitting this form you are giving ACC-NET the right to charge your Credit Card the appropriate amount for the service selected.