US Net, L.L.C. The Freedom to Succeed
 

PowerSurf High-speed Dialup Service Order Form

 
Fields with an * (ASTERISK) are required.
   
 Company Name
       
 First Name * Last Name *
   
 Current E-mail *
   
 Address 1 *
   
 Address 2
       
 City *
       
State *
       
 Zip Code * Plus 4
   
 Country *
   
 Main Phone xxx-xxx-xxxx *
   
 Choose Option *
   
 Credit Card Company *
   
 Credit Card # *
   
 Name on Card (Name exactly as it appears on card.) *
   
 Expiration Date mm/dd/yyyy *
 
 Choose a USERNAME @us.net *
 
  • If you are an existing US Net dialup subscriber, enter your current Username
  • Must be unique.
  • Must be 4 to 15 characters long.
  • Must be lowercase.
  • No special characters. Only letters, numbers and dashes.
 Choose a PASSWORD *
 
  • If you are an existing US Net dialup subscriber, enter your current Password
  • Must be 6 to 10 characters long.
  • Must be lowercase.
  • No special characters. Only letters, numbers, periods, dashes and underscores.
  • Must be different from your username.