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Sign Up

Step 01 - Name, Address & Phone
FULL NAME:
COMPANY NAME:
(If Applicable)
ADDRESS LINE 01:
ADDRESS LINE 02:
CITY:
STATE:
ZIP:
PHONE: (HOME)
PHONE: (COMPANY)
EXTENSION:

CURRENT EMAIL:
(if applicable)
FAX NUMBER:
Operating System:
HOW DID YOU HEAR ABOUT CCIS?:
Were you referred? If so enter their CCIS email address. (optional)


Step 2 -Services Desired

Premium Digital Residential Wireless
   128Kbs
   1GB Data Month
   2 Email Boxes
   6 Meg Personal Web Space
$39.95/mo.
Premium Advanced Digital Residential Wireless
   256Kbs
   1GB Data Month
   2 Email Boxes
   6 Meg Personal Web Space
$89.95/mo.
SOHO Digital Wireless
   256Kbs
   2GB Data Month
   5 Email Boxes
   6 Meg Personal Web Space
$99.95/mo.
Premium Business Digital Wireless
   1Mbps
   8GB Data Month
   10 Email Boxes
   20 Meg Personal Web Space
$199.95/mo.
Platinum Business Digital Wireless
   3Mbps
   16GB Data Month
   10 Email Boxes
   20 Meg Personal Web Space
$399.95/mo.

1 Year Residential Prepaid   
10% Discount

Additional E-Mails
$3 ea./mo.
QTY.
Register/Set Up Domain Names $50*
10 mb Web Space/Domain Hosting $29.95/mo.
* Does not include Internic Fee of $70
If you would like an additional service that you don't see offered here, please let us know by filling in the form below.


Step 3 - Signing Up!
That's all the information we need to get your service started. Please take a few moments and review the above information to verify that everything is correct and complete. Links to software or configuration help will be provided after you've submitted the form.

By submitting this information you hereby agree to the terms outlined in CCIS's acceptable use and terms of service policy. You further agree that you are authorized to make charges on the credit card you are submitting and that you will be responsible for any charges that can not be validated by the credit card, including but not limited to late fees, service re-instatement fees and fines for unsolicited e-mail and news group postings as outlined in the acceptable use and terms of service. All submissions of this form track the IP address of the person submitting the form.