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Modem Access SignUp Form
Monthly Access $17.95 * Students and Seniors only $14.95

Note: DSL Sign-Ups click here

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:

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Questions? 415.892.7711



WebPerception
1701 Novato Blvd.
Suite 103

Novato, CA 94947

 

First Name

   

Last Name

   

Address

   

City

   

State

   

Zip

   

Phone

   

Fax

   

Email Address

   

Credit card #:

   

Expiration Date:

   

Payment amount:

Regular $73.35 Senior/Student $ 64.35 (check one)

   



   

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 cost is $17.95 per month, billed quarterly in advance.
There is a one time setup fee of $19.50.
The first payment TOTAL is $73.35 due at sign up time.
Each additional quarter will cost $53.85 per quarter.
Students and Seniors:
Your cost is $14.95 per month, billed quarterly in advance.
There is a one time setup fee of $19.50.
The first payment TOTAL is $64.35 due at sign up time.
Each additional quarter will cost $44.85 per quarter.
Seniors:
You are sixty years or older or a person collecting Social Security.
Billing Policy:
By joining WebPerception you agree to these policies.
User Guidelines (UG):
By joining WebPerception you agree to these guidelines.

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