First Name
Middle Initial
Last Name
Company Name
Street Address
City
State
Zip Code
Billing Address (if different)
Daytime Telephone Number
Evening Telephone Number
Current Email Address
Primary Email Account Request
Alternane Email Account Request
Email Account 2
Email Account 3
Email Account 4
Email Account 5
Business Class Internet ($59.95 per month) Please call for an appointment to schedule modem installation. 239-7700 High Speed Internet ($35.95 per month) Please call for an appointment to schedule modem installation. 239-7700 Internet Lite ($22.95 per month) Please call for an appointment to schedule modem installation. 239-7700 Dial-Up Monthly Cycle ($17.95 per month) Dial-Up Annual Cycle ($179.40 billed annually) Web Hosting ($20.00 per month)
Select Your Computer Operating System
Please select any of the following hardware that is included with your computer.
CD-ROM Ethernet Card USB Ports
Yes, I have read and agree to abide by the terms and conditions of the Internet Service Agreement and the service policies. I agree to pay Paragould Light, Water and Cable the complete price for the services selected.
"One Team, One Goal, Customer Service"
CUSI
