Rainbows.net

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If you plan to mail or fax the form, fill in the form, then print it. Mail filled out form and payment to:

Name:
Phone:
Street Address:
City:
State: (Access may not be available in some areas)
Zipcode:
Requested Username: (Will also be used for your email address. Lower case only)	@rainbows.net
Password: (At least 9 alphanumeric characters)
Payment Type:	Check Credit Card
Credit Card Type: (Only if mailing or faxing)
Credit Card Number: (Only if mailing or faxing)	____________________________
Signature: (Only if mailing or faxing. Must be same as name on credit card)	____________________________
Account Plan:
General Per month: $19.95/mo ($20.78 Tax Included) Student Per month: $17.95/mo ($20.78 Tax Included) Pre-pay 3 months: $17.95/mo ($56.09 Tax Included) Pre-pay 6 months: $16.95/mo ($105.94 Tax Included) Pre-pay 12 months: $15.00/mo ($187.50 Tax Included) Per week: $15.00/wk. $8.00 setup. ($23.96 Tax Included)
Referred By:

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