Application for Internet Access
To become a NetStream subscriber, please complete the application for internet access below. All information will be send via e-mail and kept confidential.

First Name:
Last Name:
If business,
name of business:
Address Line 1:
Address Line 2:
City:
Zip/Postal Code:
Home Telephone:
Work Telephone:
Fax Number:

Membership plans
Membership plan Max Speed Setup Fee Monthly Fee
Annual Fee
 Internet Access
Platinum Dedicated
$295.00
$150.00
$1,800.00
 Dedicated Connection
10 E-Mail Boxes
Gold Plus 128K ISDN
$50.00
$89.00
$989.00
 5 E-Mail Boxes
Full Access
Needed for network with 3 or more computers
Gold 128K ISDN
$25.00
$49.50
$504.90
 Full Access
2 E-Mail Boxes
Silver 56K
$25.00
$19.25
$196.90
 Full Access
2 E-Mail Boxes
* 3 Months Free with Annual Pre-Pay
Bronze 56K
-
$3.30
$39.60
 Additional E-Mail

Payment plans
Payment plan Frequency Benefits
Annual
Once per year
Waiver of Setup Fee & 6 Free Months with Silver Plan!
Semi-Annual
Twice per year
-
Quarterly
Four per year
-
Monthly
Twelve per year
-

Choose one: Choose one:

Payment method
Select payment method:
Applicant, if approved, hereby authorizes NetStream, Inc. to charge the credit account listed below.
Account number:
Name on account:
Expiration date Month: Year:

Existing Internet Provider:
Provider name
AOL
CSI
Prodigy
Voyager
MixCom
Other
If other: name
Reason for change:
Access
Speed
Reliability
Other reasons or comments

Account Preferences
Preferred account name:
(6-10 characters)
Mother's Maiden Name:
(used for security reasons)

Computer Equipment:
Desktop LapTop Server Type:
Computer Type:
Macintosh

IBM Compatible:

CPU Speed: Operating System:

Memory: Megabytes

Modem:
Modem Brand: Modem Speed:
 

If you would prefer not to register online, you can still subscribe by printing and faxing this page to 1-414-908-4FAX or by phoning 1-414-908-4NET. Checks or money orders are also accepted.

Just print a copy of this form and mail it to:
NetStream, Inc.
1441 N. Mayfair Road
Milwaukee, WI 53226-3253

Where Did you hear about NetStream?

                                

Before submitting, please review Terms & Conditions , User Hardware Disclaimer                                   Diagnostic Support ,  Acceptable Use.