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Want a lifetime Email Account with
the address of your
choice?
(Click here to learn more)
Please complete the form below, then print this page, and then Mail the completed form along with your payment. To have us "hold a name" while your completed form is in the mail, simply complete the form, then click the "Email It" icon.


Name:

Address:

City:
State: Zip:
Email Address: (if any)

Because some names may already be taken please enter your Email Name choices in order of preference. You will be assigned the first available name. WebPerception will contact you with your email name and password. Please allow forty-eight hours for your account to be activated.
(Email names can be up to 20 characters not counting the @YourDomain.com)

Preference Number 1:
EmailName:

Preference Number 2:
EmailName:

Preference Number 3:
EmailName:

Domain Name Choice:

Payment will follow for one quarter ($20)
Payment will follow for six months ($35)
Payment will follow for one year ($65)

Please mail the completed form with payment to:

WebPerception
1701 Novato Blvd. Suite 103
Novato, CA 94947
telephone: 415.892.7711 fax: 415.898.3974

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For more information regarding our internet services please telephone 415.892.7711
WebPerception © since 1995