Palmer Mutual Telephone Company

Dial-up Internet Application
Services provided through Northwest Communications

CUSTOMER INFORMATION

*Name:

*Street Address:

*City:

*State: *Zip:

Billing Name (if different):

Mailing Address:

City:

State: Zip:

*Home Phone:

Daytime Phone:

Fax:

Your Mother's Maiden Name (For Security):

*1st Requested E-Mail Address
(no punctuation):
@ncn.net

*2nd Requested E-Mail Address:
(if 1st isn't available):
@ncn.net

E-Mail Address Note: Eight characters or less.
If yours is unacceptable or unavailable, one will be chosen for you.

*Denotes Required Fields

INTERNET PLANS

	Plan I: Res/Bus $20.00 Monthly 250 hours/month ** Installation Fee: $10.00 Includes Installation Software and Welcome Booklet.
Web TV Connection
**Hours in excess of plan limit will be billed on a per hour basis.

FILTERING OPTIONS

Postini® Spam Filtering Package: $3.00 per month. Web Content Filtering: $5.00 per month.
Combined Spam & Content Filtering Package: $6.00 per month. (Best Value!)
Click here for more information regarding these options!

ADDITIONAL E-MAIL ADDRESSES

You may request additional addresses for $3.00/month for Residential and $5.00/month for Business accounts. In addition, you can activate Postini e-mail filtering for $3.00/month per e-mail address.
1st Additional E-Mail Address (no punctuation): @ncn.net Include virus and spam Filtering 2nd Additional E-Mail Address (no punctuation): @ncn.net Include virus and spam Filtering	3rd Additional E-Mail Address (no punctuation): @ncn.net Include virus and spam Filtering 4th Additional E-Mail Address (no punctuation): @ncn.net Include virus and spam Filtering
Note: Eight characters or less. If your choice is unacceptable or unavailable, one will be chosen for you.

COMPUTER SYSTEM

	MINIMUM REQUIREMENTS:	WE RECOMMEND:
Modem Memory PC CPU PC OS Mac CPU Mac OS	33.6 kb 64 MB of RAM Pentium or AMD K6-2 Windows 98 Power PC System 8	56k w/ x2 128 MB or More Pentium III or AMD K7 Windows 2000 or XP G3 System 9 or Higher

CUSTOMER SERVICE AGREEMENT

I understand and acknowledge that continued use of Northwest One's services constitutes acceptance of the Terms of Service, Acceptable Use Policy and other important policies posted on Northwest's Website www.ncn.net. I agree it is my responsibility to read these policies and comply fully with their terms. I further understand the policies and pricing of Northwest's Services may change from time to time upon 30 days notice. The Service is provided on an "AS IS" and "AS AVAILABLE" BASIS WITHOUT WARRANTIES OF ANY KIND, EITHER EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO WARRANTIES OF TITLE OR IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.

I agree to the terms in the Customer Service Agreement.

If you do not agree, click this button to exit without submitting this application: