Please provide the following contact information:

Name
Title
Organization
Street Address
Address (cont.)
City
State
Zip Code
Work Phone
Home Phone
FAX
Best Time to Call
Current ISP
E-mail Address

Please check if you are one of the following:

Central Virginia Electric Cooperative Member

Central Virginia Electric Cooperative Employee

If you checked Central Virginia Electric Cooperative Member, what is your account number:  

Please select a monthly service plan:

$14.95 Monthly
$179.40 Annually

For any other needed services, please call Ceva.net at 1-877-444-2382.  For Technical Support call 1-866-595-5409.

Choose one of the following payment options:

Credit Card
Electric Bill (CVEC Members Only)
Checking Account Debit/Bank Draft

Please provide your account information:

* Only the Primary User-ID can be used to connect to the service.

Please provide one of the following items of information to identify you for account verification purposes:

SSN
DOB
DL#
DL State
Maiden Name
Secret

How did you hear about Ceva.net?

Newspaper
Radio
Current Communicator
Direct Mail/Brochure
Friend or Ceva Customer
Other

If you checked Friend or Ceva Customer, please tell us their name:

If you checked Other, please tell us more:  

To complete your sign up please choose one:

I will call Ceva.net at my earliest convienience toll-free at 1-877-444-CEVA (2382)

I would like Ceva.net to call me back during the hours I specified above.

Applicant Signature:__________________________________________________

This form can be filled out on-line, when finished either click on submit or print and mail the form to Ceva.net at:

Central Virginia Services, Inc.; P.O. Box 506; Lovingston, VA 22949

By clicking on Submit you are doing the same as signing this form.

DO NOT forget to print a copy of this form for your self!