Internet
Service
Provider

Internet User Account Application

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 select a monthly service plan:

$14.95 Monthly
$179.40 Annually

All Packages are unlimited dial-up service and up to 5 E-mail accounts.

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

Choose one of the following payment options:

Credit Card
Checking Account Debit/Bank Draft

Please provide your account information:

User-ID is 8 characters maximum, all lower case.  Password is 8 characters maximum, upper or lowercase.
User-ID @ceva.net Primary/First E-mail Address Second E-mail Address Third E-mail Address Fourth E-mail Address Fifth E-mail Address
First Choice
Second Choice
Password
Password Comfimation

* 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 1-866-595-5409

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:

TruTechnology LLC (dba CEVA.net); P.O. Box 38; Boyd, WI 54726

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

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