Dialup - Internet Registration Form

	Dialup Package Options Please select from the available plan options below
	CM Lite - unlim hrs, 50mb d/loads, 1email, 0Mb host, 9.9c/Mb exc data fee $19.95 /mth CM Budget - unlim hrs, 300mb d/loads, 1email, 0Mb host, 9.9c/Mb exc data $21.95 /mth CM Advanced - unlimited hours, unlimited downloads, 3 emails, 5 Mb host $24.95 /mth CM Mega - unlimited hours, unlimited downloads, 5 emails, 10 Mb host $34.95 /mth

	LOGIN DETAILS
	Username:   The username forms part of your email address, and must be at least 5 but no more than 16 characters long. Most customers choose a combination of their firstname and surname (e.g. jsmith, smithj, johnsmith) Second Preference Username:   Third Preference Username:         Password:   Confirm Password:   The password must be between 6 - 8 characters long.

	CUSTOMER DETAILS
	First Name Last Name Company Address   Town/Suburb State WA NSW QLD VIC ACT SA NT TAS Postcode Please ensure you enter the area code for any phone numbers supplied. Home Phone Fax Work Phone Mobile Email

	PAYMENT Please select from the available payment options below
	- from your cheque or savings account and payable to CM Internet Cheque/Money Order - payable to CM Internet and post to CM Internet Direct Deposit - deposit your cash, cheque or money order at any Bankwest branch Credit Card - a 2.2% surcharge will be charged for all credit card payments.

	TERMS & CONDITIONS
	I declare that I have read, understood and agree to abide by CM Internet's Terms & Conditions. Click here for a printable version of the terms & conditions. You must have Adobe Reader 6 installed. To update or install Adobe Reader click here.