EFlash.com
Independent Flashnet Representative
 Print/Order Form To order, select plan below complete this form, print, then 
Fax, to 361/668-0036 or Mail (with payment) to the address at the bottom 
of the page. Or press "Submit" to email. Independent Flashnet Rep ID: 1121498
Popular Flashnet accounts include: Modem service 14.4,  28.8, 33.6 & 56k where available. No hourly charges,
2 email account, 5 megs WWW space for business or personal, limited tech support. Unless otherwise specified.

Customer Information

Your entry must match the name and address on your credit card, or your bank may decline the offer. All information is kept confidential unless you tell us otherwise. Your telephone or fax number helps us contact you for technical and billing questions.

Please feel free to write other information you think is necessary
 

FIRST NAME
MIDDLE
LAST

STREET ADDRESS

CITY
STATE
ZIP CODE

Home phone (with area code)
Work phone (with area code))

Company name
Job Title

Secret Word (i.e., mother's Maiden name)
How did you hear about us?

Operating System
Browser Type
Fill by hand 
on the field		 Op. sys: (circle one) Win98,   95   3.x   NT   MacOs   OS2   Other __________
Browser (circle one) Explorer     Netscape      Mosaic      Other _____________
Service information Fill by hand if other :
Select
Plan
Your User ID  Password
Enter a User_ID & PW you prefer. Maximum 8 Characters

Your Email Address

E-MAIL ADDRESS (one address only, no Web sites) i.e.,yourname@xyz.com(optional)

Payment Information

All of your payment information is kept strictly confidential.
 
 

 
Visa Master Card Discover American Express
CARD NUMBER: CARD EXPIRES:

YOUR SIGNATURE:
_________________________________

Check or Money Order: Make checks and money orders PAYABLE TO FLASHNET drawn from a U.S. bank or from an international bank with funds specified explicitly as U.S. dollars. Please send this completed form with your order.
Print & Fax 361/668-0036
or Mail with payment to:
Payable to Flashnet
Mail or fax to EFlash.com
Flashnet independent Representative
427 So. Reynolds St.    Alice, Texas 78332
If you preferred you can email this form here
this is a secure site. just press: submit.
This web page and web site has been developed and is maintained exclusively by RE Enterprises, DBA Eflash.com an Independent
FlashNet Representative. As FlashNet modifies its products, programs, and policies, information contained in this web site is subject to change.
This web site is not authored ,sponsored or maintained by FlashNet Communications or FlashNet Marketing Inc.