Follow these simple steps: 1. Fill in the form completely. 2. Paying by credit card? Click the "Email It" icon at the bottom of this Signup Form (below) after you have filled in the form. 3. Or you can print and fax the form with credit card information to 415.898.3974 4. If you're paying by check then print and mail the form with payment to:	Questions? 415.892.7711 WebPerception 1701 Novato Blvd. Suite 103 Novato, CA 94947

First Name
Last Name
Address
City
State
Zip
Phone
Phone you want the DSL on (if different)
Fax
Email Address
Credit card #:
Expiration Date:
Payment Amount:	To check pricing click here
Residential	BronzePlus
Business	BronzePlus

The following information is for your email account:
Choose your login name:	• Login name limited to sixteen characters • Your 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

Payment:
The price for your DSL account varies according to type of service you choose.
Billing Policy:
By signing on with WebPerception you agree to these policies.
User Guidelines (UG):
By signing on with WebPerception you agree to these guidelines.

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For more information regarding our internet services please telephone 415.892.7711
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