Internet Application

By completing the form below, you agree to comply with all FTC-I.Net Terms and Conditions and accept full financial responsibility for services rendered by FTC-I.Net. Your application will not be processed unless all information is complete. Within 72 hours, your username and password will be sent to you via US Postal Service at the mailing address entered below. If you need more information about FTC-I.Net Click Here or call your local FTC Customer Service Department.

Contact Information

First Name: *

Middle Name:

Last Name: *

Phone: *

Email:

Business Name: (if applicable)

SSN:

Business / Home Address

Street Address: *

PO Box:

City: *

State: *

Zip: *

Service Information

You must select one option.

Type of Internet Service:

DSL Business - $44.95/month

DSL Residential - $34.95/month

DSL Employee

FTC Provided Router NONE

Customer Provided Router NONE

Unlimited Dial-Up Monthly Plan $19.50

Unlimited Dial-Up Annual Plan $198.00
($36 savings)

Basic Dial-Up Plan $11.50 for 20 hours
($1.00 each additional hour)

Other (Frame Relay, ISDN)
Call 1-800-671-0669 for details

Username

You must supply three usernames and security code.
4-12 characters Subject to Availability

Username #1 (1st Choice)

Username #2 (2nd Choice)

Username #3 (3rd Choice)

Security Code:
(i.e. Mother's maiden name, pet's name, etc.)

Notes, Questions, Comments:

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Internet Application