P o r t l a n d ' s I n t e r n e t S e r v i c e P r o v i d e r
Current PDX Conditions:
Credit Card signup form for new members
You can also sign-up with our Secure Online Form. CLICK HERE.
Print this form and mail (or FAX) to:
Hevanet Communications - 320 SW Stark Suite 419 - Portland,
OR 97204 Phone: 503-228-3520 Fax: 503-274-4144
You can use this form if
you want to sign up with Hevanet using a credit card. You can either print
out the form and mail it, or you may fax it to us. We will process your
application within 24 hours of receiving it. Paying with check
is also available.
By signing this contract, I understand all of
the following:
That my credit card will be automatically billed on a periodic
basis as a pre-payment for services to be provided the following period.
(if chosen). I must notify Hevanet in writing, with 30 days advance notice
of my request to discontinue this automatic charge agreement. I understand
that Hevanet may continue to charge the card provided, for all fees and
charges due until I change my payment method or cancel my account. Hevanet
makes no warranties of any kind for the service it is providing and is
not responsible for any damage I or another party may suffer. Hevanet may
only be used for lawful purposes. All sales are final. All charges are
non-refundable. I have read and agree to the Service
Agreement.
Type of Card:
Name on Card:
Expiration Date:
Card Number:
Phone Number:
Address:
Fax Number:
City/State/Zip
Operating System:
Preferred Email: (8 characters or less)
or
Please respond via:
Referred By:
I authorize Hevanet to charge my credit card in advance
for Internet dial-up access. I have checked the option I want below (check
one):
