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	<h2>Message Express Internet Account Application</h2>

	<a href="http://www.barryarea.com/" > <strong><u>Barry County Telephone Co. Home</u></strong></a>

	<a href="/" > <strong><u>Message Express Internet Home</u></strong></a>

	<p><b>For additional assistance, please call (269) 623-9005, (269) 721-9005, (269) 758-9005, or (269) 664-9005 to sign up.</b></p>

	<p><i><b>The following information must be completed in full for an account to be assigned.  This form is an agreement for service under a specified set of <a href="oterms.xml">terms and conditions</a>.</b></i></p>

	<form action="meimail.pl" name="AppForm" onsubmit="return validate()"><input name="to" type="hidden" value="sales" /> <input name="redirect" type="hidden" value="othanks2.xml" /> <input name="subject" type="hidden" value="MEI Application" /> <input name="realname" type="hidden" value="Online Application Form" /> <input name="email" type="hidden" value="webmaster@mei.net" /><h3>Personal Information:</h3><table class="borderless" width="100%"><tr>
<td align="right" width="20%">Your Name</td>
<td width="80%"><input name="n01Name" size="25" type="text" /></td></tr><tr>
<td align="right" width="20%">Address</td>
<td width="80%"><input name="n02Address" size="30" type="text" /></td></tr><tr>
<td align="right" width="20%"></td>
<td width="80%"><input name="n03Address2" size="30" type="text" /></td></tr><tr>
<td align="right" width="20%">City</td>
<td width="80%"><input name="n04City" size="20" type="text" /> State <input maxlength="2" name="n05State" size="3" type="text" /> Zip <input name="n06Zip" size="12" type="text" /></td></tr><tr>
<td align="right" width="20%">Telephone</td>
<td width="80%"><input name="n07Telephone" size="20" type="text" /></td></tr><tr>
<td align="right" width="20%">Fax</td>
<td width="80%"><input name="n08Fax" size="20" type="text" /> * Optional</td></tr><tr>
<td align="right" width="20%">Mother&#39;s Maiden Name</td>
<td width="80%"><input name="n09Maiden" size="15" type="text" /> (For Account Security)</td></tr><tr>
<td align="right" valign="top" width="20%">Comments</td>
<td width="80%"><textarea cols="50" name="n10Comments" rows="5" wrap="soft"></textarea></td></tr></table><h3>Account Information:</h3><table class="borderless" width="100%"><tr>
<td align="right" width="40%">Desired Account Name (3 to 14 lower case characters)</td>
<td width="60%"><input maxlength="14" name="n11Account" size="14" type="text" /> @mei.net</td></tr><tr>
    
<td align="right" width="40%">Password</td>
<td width="60%">
    <input id="passent" maxlength="14" name="n12Password" onChange="ajaxpval(this);" size="14" type="password" /><span id="passres"></span></td></tr><tr>
<td align="right" width="40%">Operating System</td>
<td width="60%"><select name="n13OS" size="1"><option>Win95 </option><option>Win98 </option><option>WinMe </option><option>Win2000</option><option>WinXP </option></select></td></tr></table><p><br /></p><h3>Select Account Types and Services</h3><table class="borderless" width="100%"><tr>
<td align="left" width="33%"><u>Type/Service</u></td>
<td align="left" width="33%"><u>Price</u> <span style="font-size: small;">(also check: <a href="/oproducts.xml">products</a> / <a href="/opromotions.xml">promotions</a>)</span></td>
<td align="left" width="33%"><u>Comments</u></td></tr><tr>
<td align="left" style="border-style: solid; border-width: 1" width="33%"><input name="n14service" type="radio" value="Basic Account" />Basic Account </td>
<td align="left" style="border-style: solid; border-width: 1" width="33%">$9.95 per Month</td>
<td align="left" style="border-style: solid; border-width: 1" width="33%">The Basic Account, 3 Month, 6 Month, and 12 Month Unlimited, include up to three e-mail accounts and personal web space.</td></tr><tr>
<td align="left" style="border-style: solid; border-width: 1" width="33%"><input name="n14service" type="radio" value="3 Month Unlimited" />3 Month Unlimited </td>
<td align="left" style="border-style: solid; border-width: 1" width="33%">$24.95 per 3 Months</td>
<td align="left" style="border-style: solid; border-width: 1" width="33%">  </td></tr><tr>
<td align="left" style="border-style: solid; border-width: 1" width="33%"><input name="n14service" type="radio" value="6 Month Unlimited" />6 Month Unlimited </td>
<td align="left" style="border-style: solid; border-width: 1" width="33%">$49.95 per 6 Months</td>
<td align="left" style="border-style: solid; border-width: 1" width="33%">  </td></tr><tr>
<td align="left" style="border-style: solid; border-width: 1" width="33%"><input name="n14service" type="radio" value="12 Month Unlimited" />12 Month Unlimited </td>
<td align="left" style="border-style: solid; border-width: 1" width="33%">$79.95 per 12 Months</td>
<td align="left" style="border-style: solid; border-width: 1" width="33%"><span style="font-size: small;"> Specials may apply! Lower prices on our <a href="/oproducts.xml">products</a> or <a href="/opromotions.xml">promotions</a> pages (within their offer dates) will be applied automatically. </span></td></tr></table><p> </p><h3>Bill Monthly Charges To:</h3><p>    <input name="n17paytype" type="radio" value="Phone Bill" />Phone Bill (Barry County Telephone Co. customers only)<br />     <input name="n17paytype" type="radio" value="Mastercard" />Mastercard<br />     <input name="n17paytype" type="radio" value="Visa" />Visa<br /></p><p>   <b> To authorize billing the monthly charges to your credit card, please complete this form, submit it, and then call (269) 623-9005, (269) 721-9005, (269) 758-9005, or (269) 664-9005. </b></p><hr /><p><b>Important Notice: Your account will be activated within one business day of receiving your application. Your Visa/Mastercard will be charged on the day of activation.
    MEI.net does not apply recurring charges.  You will receive a bill by mail. Message Express requires 30 days notice to disconnect service.</b></p><hr /><div align="center"><p><b>***** FRIEND&#39;S PROMOTION *****</b></p></div><div align="center"><p><b>&#34;SIGN UP A FRIEND AND WE&#39;LL GIVE YOU ONE MONTH FREE&#34;</b></p></div><div align="center"><p>FRIEND MUST BE ON-LINE FOR 30 DAYS &#38; MEI WILL CREDIT YOUR ACCOUNT</p></div><hr /><div align="center"><p><b><i>I have read and agree to the <a href="oterms.xml">terms and conditions</a> as stated by MEI. I affirm that I am legally qualified to contract for Internet service and have attained the age of at least 18 years. (If under the age of 18, a parent or guardian must contact MEI). Contact MEI by phone at (269) 623-9005 or (269) 721-9005, (269) 664-9005, or (269) 758-9005 or by email at <a href="mailto:sales@mei.net">sales@mei.net</a>, or by mail at:</i></b></p></div><div align="center"><p><b><i>Message Express Internet<br /> P.O. Box 127<br /> Delton, MI  49046</i></b></p></div><dl><dd align="center"><div align="center"><p><input name="submit" type="submit" value="Submit" />                                                <input name="B1" type="reset" value="Reset  " /></p></div></dd></dl></form>

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