Marinmarket.com
P.O. Box 1408
Mill Valley, CA 94942-1408
Phone: (415) 506-0319
Fax: (415) 506-0321
Email: webmaster@marinmarket.com
Web Address: http://www.marinmarket.com

Internet Access Sign-up Form

MarinMarket.com provides 56K unlimited local Internet access to Marin County residents.

• A dial-up and email account costs $15.00 per month. No set-up fee!
• Technical support 24 hours a day 365 days per year!
• No long telephone hold times!
• Assistance with installation and maintenance.

PRIVACY STATEMENT

The information you disclose to MarinMarket.com will not be sold or distributed to any person, business, organization or third party. It will be used only by us for the purpose of fulfilling your request and providing you with additional information on services offered by MarinMarket.com.

Please fax or mail your completed Internet Access Sign-up Form to the contact information listed at the top of this page. (THIS APPLICATION IS FOR MARIN COUNTY RESIDENTS ONLY.)

Contact Information:

Name:
Business Name:
Address:
City:
State:
Zip:
Phone Number:
Fax Number:
E-mail(required):
Web Site Address:

Credit Card Information:

Card Holder:
Credit Card Number:
Expiration Date:

Set-up Information:

User name (Up to 16 characters):
(Your user name is the beginning part of your email address. For example: username@marinmarket.net)
Password (Case sensitive):
(Your password can be letters and/or numbers. No Spaces!)

Please select your computer's operating system:

Windows XP Windows NT Windows 98 Windows 95 Macintosh (must be version 8.0 or higher)

Please select your computer's email software:

Netscape 4.0 or above Netscape 3.0 Internet Explorer Eudora Microsoft Outlook

Keep your user name and password in a safe place!

Please allow two to three business days to activate your account.