Subcription Form

I would like to sign up for North Coast Internet Service

Name ____________________________________________________________

Address __________________________________________________________

City ______________________ State _____________ Zip Code _____________

Phone Number _________________________________

Username ( 8 characters maximum ) ________________________

___ I already have internet software

___ I need internet software

___ I need assistance with installation

Version of software needed: ___ MAC ___ Windows 95 ___ Windows 98__ Windows 2000

Subscription Rates

Monthly Subscription Level ( select one ):

___ $6.95 ( including 15 hours of on-line time )

___ $19.95 ( including unlimited hours of on-line time )

Setup Fee $19.95

Please include sales tax ( 5.5% )

Make checks payable to:

North Coast Internet Services, Inc.

1901 Beaser Ave

Ashland, WI 54806

715-682-8830

For Further Information Contact:

North Coast Internet Services, Inc.
P.O. Box 947 Ashland, WI 54806
Tel: 715-682-0180
e-mail:info@ncis.net
URL: http://www.ncis.net