FLASHFLOW MAIL-IN SIGNUP FORM
(For Check or Money Order Payments)
Print this blank form, attach payment and mail to the address below. You will be contacted when your payment is received.

Customer Information

Name:       _________________________________

Address:   _________________________________

City:         _________________________________

State, Zip: _________________________________
Date: _____/_____/_____

Company Name: _____________________________

Daytime Phone #: ____________________________

Evening Phone #: ____________________________
Account Information
Choose a 
User Name:
___ ___ ___ ___ ___ ___ ___ ___ ___
  *     *     *
(Will also be the primary email address)		 Choose a 2nd email Name:
___ ___ ___ ___ ___ ___ ___ ___ ___
  *     *     *
(Will be the secondary email address)
Choose a
2nd choice :
___ ___ ___ ___ ___ ___ ___ ___ ___
  *     *     *		 Choose a Password:
___ ___ ___ ___ ___ ___ ___ ___ ___
  *     *     *
Choose a Password:
___ ___ ___ ___ ___ ___ ___ ___ ___
  *     *     *		 The following is used as a security measure to allow
changes to account.
Criteria: * =Manditory Fields.  Minimum of 3 characters, maximum of 9. Letters, numbers, "-" and "_" are permissible. Security Password:
___ ___ ___ ___ ___ ___ ___ ___ ___
  *     *     *
(example: mother's maiden name)
Internet Package Choice   please check one


  56K Dialup Account - $131.40 (12 Months) = $10.95/month
   56K Dialup Account - $77.70    (6 Months) = $12.95/month
   56K Dialup Account - $44.85    (3 Months) = $14.95/month

 64K ISDN Dialup Account - $215.40 (12 Months)    = $17.95/month
   64K ISDN Dialup Account - $119.70 (6 Months)      = $19.95/month
   64K ISDN Dialup Account - $65.85 (3 Months)        = $21.95/month
   64K ISDN Dialup Account - (Minimum 3 Month Agreement)  $24.95/month
*add $25 setup fee for each account set-up
Method of Payment   please check one

   Check (Payable to: ImagePro Communications)
   Money Order (Payable to: ImagePro Communications)
Mail Payment To:

  ImagePro Communications
  FlashFlow Internet Services New Accounts
  207 Commerce Drive
  Dallas, GA 30132