Geetel Communications Inc.   9155 N Co RD 200 E, Frankfort, IN 46041
office use only
Entered on Server: _____________     Reference #:__________________
Billing Software:______________     Check #_____ Cash____ CC_____
Software Sent:________________     Amount:_____________________

 
Dial Up Numbers:  Tech Support #:  258-HELP (local) or
Burlington, Cutler, Frankfort, Geetingsville, Michigantown: 258-5600 877-99GTELL (toll free)
Delphi and Flora: 268-2525, 268-2175, and 268-2544 Mon - Fri: 8:00 AM - 6:00 PM
Buck Creek, Clarks Hill, Lafayette, Mulberry, Rossville, Stockwell: 296-4400  Sat: 9:00 AM - 12:00 PM

Name:________________________________________________________________________
Company Name:________________________________________________________________
Address:______________________________________________________________________
City:___________________________________ State:________ Zip:______________________
Telephone Number:_____________________________________________________________
Mother’s Maiden Name:__________________________________________________________

Choose an EMAIL name up to 8 characters, all lower case:____ ____ ____ ____ ____ ____ ____ ____

Choose a PASSWORD up to 8 characters, all lower case:____ ____ ____ ____ ____ ____ ____ ____

Circle One:  WinXP  Win00 WinMe Win98  Win95    Mac WebTV    Other:________________________

____ Starter Package        $14.95/month + $10.00 initial setup fee           150 hours usage
____ Unlimited Package $18.95/month + $10.00 initial setup fee    unlimited usage
____ Family Package $24.95/month + $10.00 initial setup fee    unlimited usage + 3 email addresses
____ 1 Year Limited $160.00 – a one time payment, non-refundable after 30 days  300 hours usage per month
____ 1 Year Unlimited $180.00 – a one time payment, non-refundable after 30 days unlimited usage

____ Filtered Internet  $5.00/month   blocks adult web sites
____ Yearly Filtering $50.00 – one time payment  blocks adult web sites
____ Extra email address  $5.00/month

Bill Me Monthly____________

Charge My Credit Card Monthly______________

VISA MC DISCOVER Account# ___________________________________ Exp. Date_____

I hereby certify that the above information is correct, that I have read the Acceptable Use Policy on the
back and that I agree to use the Internet in a legal, ethical and positive manner.

SIGNATURE: _________________________________________________ Date: ___________________

Monthly usage begins on the 1st of each month at 1:00 a.m.  Charges to credit cards will be made on the
17th of each month. Unlimited access is defined as 744 hours, which is equal to 24 hours, 31 days a month.
There will be a $35.00 trip charge for any in-home Internet setup during normal business hours and $45.00
charge outside of normal business hours. Normal business hours are defined as Mon-Fri: 8:00 AM - 5:00 PM.