Date:

Name:

Address:

City:

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Zip Code:

Area Code: Phone Number:
Area Code: Work Phone:

Account Type: Monthly Internet Access - $20.00
Semi-Annual Internet Access - $100.00
Annually - $180.00
Additional Email Box - $1.00/Month
Additional 5MB Webspace - $5.00/Month
Internet accounts include 1 email box and 5 megabytes of personal webspace.

Login: Login and Password should be all lower case and contain at least three and not more than eight characters. The first character will need to be a letter. Login names are available on a first come first served basis. If your requested login is not available, you will be notified. Your password will appear as asterisks.
Password:
Re-Enter Password:

How did you hear about CityScape? (Check all that apply):
Radio advertisement
Newspaper advertisement
Phone Book
Online advertisement
From a CityScape employee
From a CityScape customer
From a friend
I used my favorite search engine

Operating System:
Windows 98
Windows 95
Windows 3.1
Other

Payment Option:
Visa/Mastercard
Invoice

Thank you for choosing CityScape Communications for your Internet needs. A representative will contact you regarding your new account as soon as possible.

Members agree to abide by our Users Agreement.
� 1999 CityScape Communications, Inc.
400 South Grand Avenue East
Springfield, Illinois 62703
Springfield: 217.535.1010 or 888.248.9722
Fax:217.535.1009 Jacksonville: 217.243.3997
Customer Service: 217.535.1010 or 888.248.9722
Technical Support: 217.535.1010 or 888.248.9722

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