Pay by Check / Money Order Form

This form can be used for both new accounts and existing accounts who choose to pay by check or money order.

Please print this form, fill it out and mail it in. Allow 1-2 weeks for account to be upgraded. If an existing customer you will be notified through your basicisp.net email of receipt of payment. If you are a new account, we will call you at the phone number you provide upon receipt of this form.

Please check one: I am an existing customerI am signing up for a new account

Please check one:
Standard Service Monthly $8.95 ($6.95 + $2 processing Fee) Standard Service 6 Months $41.70Standard Service Yearly $83.40
Accelerated Service 6 Months $59.70Accelerated Service Yearly $119.40

Name:
Address:
City, ST, Zip:
Phone Number:
(This will only be used to contact you if there is a problem with your payment or setting up your account)
User ID:
(New users: fill in the username that you would like; this will be the first part of your email address "userid"@basicisp.net)
Second choice of User ID:
	(For new accounts only)
Password:
	(new users: fill in the password that you would like)
How did you hear about us?
Referral or Promotional Code:

If you need to pay monthly, we suggest using either a credit card or debit card to do so. Both card options are billed at the $6.95 per month rate and allow you instant access upon verification of the card. If you choose this option. you may sign up today at www.basicisp.net, or by calling us at 800-456-3118.

You will receive a renewal notice in the mail when your subscription nears expiration each month or next year. At that time you may send another check or money order to renew your subscription.

Mail To:
BasicISP.net
Pay by Check Dept.
P.O. Box 511
Mount Vernon, OH 43050