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Application Form
Complete your details to open an Internet Access Account
If you have a forms capable browser, there is an online application form on this page.Save this form, fill it out and post it with your cheque/PO for either £129 or £28.25, together with the a completed Standing Order Mandate for monthly payments, to:
- Wirenet Amiga Internet
- 39 Larch Avenue
- Penketh
- Warrington
- WA5 2AZ
- 39 Larch Avenue
Your startup pack will be mailed out within two working days of receiving your application.
YOUR DETAILS Name: Current email: Telephone: Address: INTERNET ACCESS ACCOUNT DETAILS You will be allocated an internet address of the form userid@hostname.u-net.com Please give your choice of userid and hostname: Userid: ______________ 2 - 8 lower case characters - your "handle" Hostname: ______________ 2 - 15 lower case characters - your computer's "handle" 2nd choice: ______________ Password: ______________ 6 - 8 lower case letters The software and installer is usually posted out on disks or CDROM. If you have an existing Internet connection with the means to transfer downloaded files to your Amiga, you may opt to download the software instead. If you have bought the NetConnect software pack you should use that instead of the Wirenet software. Please mark ONE of the following options: __ Software on disks __ Software on CD __ Download software __ Use NetConnect
Thank you - now please send this form, cheque/PO, and Standing Order Mandate, for a monthly subscription, to the address at the top of the page.
Your account will opened within two working days of receiving your cheque.| IMPORTANT: | When printing out this form, please ensure that the Standing Order Mandate appears on a single plage. If it is split across two pages, the bank will not accept it. |
Standing Order Mandate
To the Manager .................................................... bank Address .................................................... .................................................... Sort code: .............. Account number: .................. Account name: .................................................... Please pay the sum of £14.25 into the account below on the 1st/15th* of each month, beginning with the month of ........... Sort code: 20-91-48 Account number: 70162094 Account name: Wirenet Signature: .................................. Date: .................................. Telephone: ..................................* The standing order must be paid on the date soonest before the renewal is due. i.e if you subscribe before the 15th, then select the 1st. If you subscribe after the 15th, select the 15th. Your subscription renewal date remains on monthly intervals from the date the account is opened.
This page was last updated on Wednesday 03 November 1999.