Sneaker Net

APPLICANT DETAILS

    Name:    ______________________________________________________________

    Address: ______________________________________________________________

    Ph Home: _______________  Work: _______________  Other: _______________

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SERVICE REQUIRED

Account Required (tick one)
        [ ] Virtual Only    [ ] Company Virtual    [ ] Dedicated Virtual
Account Name (Please fill in 3 options for the account name. Min.3 Chars - Max.8)
  Opt 1:____________  Opt 2:____________  Opt 3:____________  Password:___________
Additional Mailboxes (Please fill in 3 options for the account name. Min.3 Chars - Max.8)
  Opt 1:____________  Opt 2:____________  Opt 3:____________  Password:___________

  Opt 1:____________  Opt 2:____________  Opt 3:____________  Password:___________

  Opt 1:____________  Opt 2:____________  Opt 3:____________  Password:___________

  Opt 1:____________  Opt 2:____________  Opt 3:____________  Password:___________       
If you require more mailboxes please copy this sheet as required.
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How did you find out about Sneaker Net?
   [ ] A friend   [ ] Print Advertising   [ ] Internet   Source Name:______________  
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SERVICE AGREEMENT
I have read, understand & agree to the terms indicated in the Account Terms Document on this site in the following location: 'http://www.sneaker.net.au/docs/business/webterms.html'. Signed: _____________________ per account applicant.
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Please allow around 24 hours for new dial-up accounts to be configured. Dedicated accounts require a unique line and modem to be set-up and may take several days depending on phone line connection. Once payment has been received, and the requested service is active, a Sneaker Net representative will contact you with the information you require to get you started.
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