WebPerception

Sign Up Now for DSL

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.

First Name
Last Name
Address
City
State
Zip
Phone
Fax
Email Address
Credit card #:
Expiration Date:
Payment amount: (check one)	$50 one-time DSL installation fee plus check one: $29.95 monthly service fee for accounts for 768kbps x 256kbps $49.95 monthly service fee for accounts 0f 3072kbps x 768 kbps

Choose your login name:

• Login name limited to sixteen characters
• Login name is also your email address
• LoginName@MarinCounty.net

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

768kbps x 256kbps Account Payment:
Cost is $29.95 per month, billed monthly in advance, plus a one-time setup fee of $50.

3072kbps x 768kbps Account Payment:
Cost is $49.95 per month, billed monthly in advance, plus a one-time setup fee of $50.

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.