Application for Internet Service

NORLOFF COMPUTER CORP.
P.O. Box 3271, Oakton, VA 22124
BBS: (703)242-4482, VOICE: 703-242-4480

Please complete this application and sign the attached contract then mail them to the above address. Your account will be activated within 48 hours after receipt of a properly completed application, a signed contract, the set-up fee and the first month's usage fee.

Company name: __________________________________________________________
(Complete this field only if this application is for a corporate account.)

Individual name: _______________________________________________________
(If this is a corporate account, this must be the authorized signatory.)

Street address: ________________________________________________________

City/State/Zip: ________________________________________________________

Day phone: ____________________________

Evening phone: ____________________________

User id: ______________ (Note: 8 significant characters, all lower case)
(If the user id that you request is currently used by another user, then we will call you for a new user id.)

Password: _______________ (Note: 8 significant characters, all lower case)

Credit Card Number: ________________________________

Expiration Date: ________________
(Visa, Mastercard, Discover, and AMEX are accepted. If you prefer to pay by check, please enclose a check for startup costs and 6 or 12 months service. If the account is closed early, a prorated refund will be made.)

Please put a check mark by the desired service and circle the desired service options. (Note: PPP is the prefered protocol.)

____Part-time 56K bps$19.00
____Part-time ISDN (128 Kbps)$39.00
  Protocol option (select one): SLIP -or- CSLIP -or- PPP
  Set-up fee:$20.00
Monthly billing: This account is being established with a 120 hour per month limit on connect time. Additional hours will be charged at the rate of $1 per hour for 56K bps and $2 per hours for ISDN connections.
____Dedicated 33.6 Kbps$100.00
____Dedicated ISDN (128 Kbps)$250.00
  Protocol option (select one): SLIP -or- CSLIP -or- PPP
  Set-up fee option:
     customer supplies modem $50.00
     NCC supplies modem$300.00
(Allow up to 2 weeks for the phone company to install the telephone line)
Date: _____________

Signature: _______________________________
Your signature is required to process this application

I prefer to have Internet dialer configuration:
___ Left in a message on the OS/2 Shareware BBS
___ Provided to me in a telephone call to one of the above numbers.