1access.net Customer
Application
This form must be completed in full before the activation of any services.
| 1access.net Customer ID ______ |
Application Date ________ |
| Company Name |
______________________ |
| Address |
______________________ |
| Address |
______________________ |
| City |
____________________ State _____ Zip ________ |
|
URL WebSite |
______________________ (if
applicable) |
Contact # 1 (Overall account
administration, information, technical support, etc.)
| Name |
__________________________ |
Title |
________________________ |
| Email Address |
_______________________ |
Signature |
________________________ |
| Contact Phone |
___________________ |
Contact Fax |
___________________ |
Contact # 2 (Contact for Accounts
Payable)
| Name |
__________________________ |
Title |
________________________ |
| Email Address |
_______________________ |
Signature |
________________________ |
| Contact Phone |
___________________ |
Contact Fax |
___________________ |
| Note to Customers: |
Persons not appearing on this form will not be allowed
contact with 1access.net regarding this account. 1access.net maintains strict
account security. Therefore, the person whom ISP desires to have contact with 1access.net
personel should be added to this form. |
1access.net Internal Use Only (DO NOT WRITE
BELOW)
| Accouting Username |
________________ |
| Accouting Password |
________________ |
| Account Created Date |
________________ |
| Account Created By |
________________ |
|
The 1access Accounting Username is used for deposit and
managementof all 1access.net Customer Services. This will be used in conjunction with all
customer contact. This username and password issued is also to access the online Account
Management system. |
ALL 1ACCESS.NET SERVICES ARE HELD TO THE 1ACCESS.NET
TERMS OF SERVICE DOCUMENT AND THE 1ACCESS.NET WHOLESALE SERVICE AGREEMENT
Post Office Box 193, Carver,Ma 02366
(508)866-7266 Voice, (508)866-2011 Fax
www.1access.net sales@1access.net |