FastAR.Net Customer Application This form must be completed in full before the activation of any services. Customer ID _72856_____ Application Date:________________ Company Name _____________________________________________________________ First Name: ___________________________ Last Name: __________________________ Address ___________________________________________________________________ Address ___________________________________________________________________ City : _________________________ State: _____ Zip: ______________ -________ Contact Phone: _______________________ Contact Fax: _______________________ Contact E-mail Address: ______________________________________________________ If you wish to add additional contact authorization: Company Name _____________________________________________________________ First Name: ___________________________ Last Name: __________________________ Address ___________________________________________________________________ Address ___________________________________________________________________ City : _________________________ State: _____ Zip: ______________ -________ Contact Phone: _______________________ Contact Fax: _______________________ Contact E-mail Address: ___________________________________________________ New Customer Account Setup Information [ ]150 Hrs.-$9.99 [ ]200 Hrs-$11.99 [ ]Unlimited -$14.99 [ ]FastNet High-Speed $4.99 [ ]Pay with Credit Card Online:(You will be notified within a few minutes at the email you listed above.) [ ]Pay with Credit Card/Bank Card off-line: Will be notifed in a few minutes of submission) [ ]ProPay.com [ ]PayPal (Watch for Email) [ ]Check Attached or Enclosed: Service will be activated upon receipt of payment. Choose Username: ____________________________ Password: _________________________ SETUP FOR Dialer: Username: fan________________@pop.net (username from above) Password: type in your password. Type in the dialup number for your location, Email Settings: POP3-mail.fastar.net or fastar.net Email: Username@fastar.net SMTP - mail.fastar.net or fastar.net ______________________________________________________________________________________ FastAr.Net, Internal Use: Accounting Username ________________ Accounting Password _________________ Account Created Date ________________ Account Created By _________________ The FastArNet Accounting Username is used for deposit and management of all FastAr.Net Dialup Customer Services. This will be used in conjunction with all customer contact. This username and password is used also to access the online Webmail, and contact with FastAr Dialup Site and Services. ALL FASTAR.NET DIALUP SERVICES ARE HELD TO THE FASTAR.NET TERMS OF SERVICE DOCUMENT AND THE FASTAR DIALUP NETWORK SERVICE AGREEMENT. ALL SERVICES ARE PRE-PAID. PAYMENT DUE BY THE 25TH. THERE WILL BE A $40.00 CHARGE FOR ANY RETURNED CHECKS, DECLINED CREDIT CARDS. Send Payment To: FastAr Network, 23 Humphrey Ln, Plainview, AR 72857-8831 Phone: (501) 440-1201 Fax: (888) 823-4976 Customer_Service@fastar.net Sales@FastAr.Net WWW.FASTAR.NET