Welcome to Coon Valley Telephone Cooperative

Dial-up Internet Application
Internet service provided by Coon Valley Cooperative Telephone

CUSTOMER INFORMATION

*Name:

*Street Address:

*City:

*State: *Zip:

Billing Name (if different):

Mailing Address:

City:

State: Zip:

*Home Phone:

Work Phone:

FAX:

*1st Requested E-Mail Address (no punctuation):
@coonvalleytelco.com
*2nd Requested E-Mail Address:
@coonvalleytelco.com

E-Mail Address Note: Eight characters or less. If yours is unacceptable or unavailable, one will be chosen for you.

Your Social Security Number: *Your Mother's Maiden Name (For Security):

Best Time for Installation or Contact (DSL only)

*Denotes Required Fields

INTERNET PLAN

$19.95 Monthly unlimited
Dialup Internet is available in Menlo, Nevinville, Stuart and Dexter

ADDITIONAL E-MAIL ADDRESSES

You may request additional e-mail addresses, if desired. The cost for each additional RESIDENTIAL e-mail address is $3.00/month. The cost for each additional BUSINESS e-mail address is $5.00/month. You may also request the Virus and spam Filtering Package, at a cost of $3.00/month for each additional e-mail.
1st Additional E-Mail Address (no punctuation): @coonvalleytelco.com Virus and spam Filtering Package 2nd Additional E-Mail Address (no punctuation): @coonvalleytelco.com Virus and spam Filtering Package	3rd Additional E-Mail Address (no punctuation): @coonvalleytelco.com Virus and spam Filtering Package 4th Additional E-Mail Address (no punctuation): @coonvalleytelco.com Virus and spam Filtering Package
Note: Eight characters or less. If your choice is unacceptable or unavailable, one will be chosen for you.

COMPUTER SYSTEM

	MINIMUM REQUIREMENTS:	WE RECOMMEND:
Modem Memory PC CPU PC OS Mac CPU Mac OS	14.4 kb 16 MB of RAM 486 Windows 95 68040 System 7.5	56k 32 MB or More Pentium or Higher \| Windows 98 SE PowerPC System 8 or Higher

CUSTOMER SERVICE AGREEMENT

I understand and acknowledge that continued use of Coon Valley Cooperative Telephone constitutes acceptance of the Terms of Service, Acceptable Use Policy and other important policies posted on Coon Valley's Website www.coonvalleytelco.com. I agree it is my responsibility to read these policies and comply fully with their terms. I further understand the policies and pricing of Coon Valley Services may change from time to time upon 30 days notice. The Service is provided on an "AS IS" and "AS AVAILABLE" BASIS WITHOUT WARRANTIES OF ANY KIND, EITHER EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO WARRANTIES OF TITLE OR IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.

I agree to the terms in the Customer Service Agreement.

If you do not agree, click this button to exit without submitting this application: