Sign Up Now for Dial Up

To set up and activate your connection now, just follow these simple steps.

Fill in the form below completely.

If you are paying by credit card, click the "Email It" icon at the bottom of the form. Or, if you prefer, print out the form, complete it, and fax it back (being sure to include your credit card information) to 415.898.3974.

If you're paying by check, print out the form, complete it, and mail it back with payment to:

WebPerception
1701 Novato Blvd.
Suite 103
Novato, CA 94947

If you have any questions, please call us at: 415.892.7711 extension 10

First Name
Last Name
Address
City
State
Zip
Phone
Fax
Email Address
Credit card #:
Expiration Date:
Payment amount:	Regular $64.35
Personal Dial Up Account $64.35 (includes installation fee of $19.50 plus three months of service--$14.95 x 3) billed quarterly in advance.

Choose your login name:

• Login name limited to sixteen characters
• Login name is also your email address
• Examples:
• LoginName@wans.com
• LoginName@webperception.com
• plus other domain names to choose from

LoginName

Choose your login password:

. Your password is case sensitive.
. The password can be letters and/or numbers.
. NO spaces allowed.

Password

Please check the operating system you use:
Windows 95	Windows 98	Windows ME	Windows NT	Windows 2000	Windows XP	Macintosh Mac

Payment:
Cost is $14.95 per month, billed quarterly in advance, plus a one-time setup fee of $19.50. First payment total is $64.35 due at sign up time. Each additional quarter will cost $44.85.

Billing Policy
By subscribing to any WebPerception service, you agree to abide by the company’s policies. Please read our User Guidelines before signing up.