Granite Internet Services | On-Line Application Form

Granite Membership Application

To obtain your account with Granite Internet Services Inc., complete the form below. On approval, you will receive a setup package in the mail that includes software, information and your password. Please fill out this form completely so we can process your account. Thanks for choosing Granite Internet.

This form is for processing new accounts only. To request changes to an existing account please submit an Account Change Request form.

Thank you for choosing Granite Internet Services, Inc.

General Information:

Contact Name: Company Name: (if applicable)
Street Address: Mailing Address:
Town/City: Province:
Postal Code: Telephone:
Daytime Telephone: Username:
(usually last name, first initial
maximum 8 characters)
Mother's Maiden Name:
(security purposes) Current Email Address:
(if available)

Current Operating System:

Windows 98:            Windows 95:            Windows ME:            Mac:

Windows XP:            Windows 2000:

Other (please specify):

Type of Account:

Check out our Rates and Services before deciding.
GST and PST must be added to all fees.

General Accounts:

Unlimited Account - Some restrictions apply. $24.95/month:
Mid-Use Account - 50 hours per month $19.95/month:
Low Use Account - 25 hours per month $15.00/month:
Snowbird/Cottage Account - 130 hours/year $100.00/year:
E-mail Only - No dial-up Access $24.00/year:
(minimum 12 month payment period)
Virus/Spam Filter $3.00 per month:
http://www.granite.mb.ca/general/virus_junk.html for more information

Payment Schedule:

Monthly: Bi-Annually:
Annually: Contract:

Payment Method:

VISA: Master Card:
Direct Debit: Cheque*:

*All accounts require a credit card to secure the account. You will be contacted for this information.

Comments:

By submitting this Membership Application Form you will be responsible for at least one month Internet access fees and agree to the Granite Subscriber's Agreement. Please take a moment to review this agreement before submitting your application. The agreement will open in a new window.
Subscriber's Agreement

Contact Name:		Company Name: (if applicable)
Street Address:		Mailing Address:
Town/City:		Province:
Postal Code:		Telephone:
Daytime Telephone:		Username: (usually last name, first initial maximum 8 characters)
Mother's Maiden Name: (security purposes)		Current Email Address: (if available)

Unlimited Account - Some restrictions apply. $24.95/month:
Mid-Use Account - 50 hours per month $19.95/month:
Low Use Account - 25 hours per month $15.00/month:
Snowbird/Cottage Account - 130 hours/year $100.00/year:
E-mail Only - No dial-up Access $24.00/year: (minimum 12 month payment period)
Virus/Spam Filter $3.00 per month: http://www.granite.mb.ca/general/virus_junk.html for more information