Your Full Name:			
Your Current Email address:	 
Contact Name:			(if other than yourself)
Your Title:			
Your Company Name:		
Your Street address:		 
Your City, State, Zip:		 
Your Daytime Phone No.:		
Your Fax No.:			
Your Evening Phone No.:		

1. Which service do you want?

Select Your Plan From This List 50 hours 1 Channel On-Demand Dialup ISDN or PPP (yearly prepaid) 150 hours 1 Channel On-Demand Dialup ISDN or PPP (yearly prepaid) 150 hours 1 Channel On-Demand Dialup ISDN or PPP (month-to-month) 50 hours 2 Channel On-Demand Dialup ISDN or PPP (yearly prepaid) 150 hours 2 Channel On-Demand Dialup ISDN or PPP (yearly prepaid) 150 hours 2 Channel On-Demand Dialup ISDN or PPP (month-to-month) Dedicated Dialup Analog Service - we will contact you Dedicated ISDN Service (1B or 2B channels) - we will contact you Dedicated DSL Service - we will contact you Dedicated Frame Relay Service (128Kbs to 1.544Kbps T1) - we will contact you Wireless Internet Connectivity - we will contact you Web Page Storage/Domain Name Registration - we will contact you

2. Which operating system do you use? Windows 95/98/ME Windows NT/2000 Windows 3.1 Macintosh 680xxx Power Macintosh OS/2 Warp 3 or 4

3. What would you like for your email address (8 characters or less, lowercase)?

Please provide 3 choices:
Choice #1: @whc.net
Choice #2: @whc.net
Choice #3: @whc.net

4. Payment Method:
VISA MC DISCOVER Credit Card Number Expiration Date (MMYY)
Name exactly as it appears on credit card

Any other payment arrangements must be approved in advance by WhiteHorse.

Thank you! Press this button to send us your information. We will process your account and have paperwork and software ready for you to pick up at our offices (3945 Doniphan Park Circle, Suite E) within two business days of receipt of this form.