What type of account do you require?
Business Residential

If business account, please provide your company name:

What type of access do you require?
Dial-Up (PC Modem) ISDN Cable Modem

Will you require space for a Web site?
Yes No

Do you want to add Spam and Virus Protection for $2.50/month?
Yes No

What payment method will you be using?
MasterCard Visa Check

If you will be paying monthly by credit card, please click here to complete a Credit Card Authorization Form.

Will you require one or more email addresses?
Yes No (if no, please skip the following four questions and hit "submit" at the bottom of this form)

To set up your primary email address, you will need to specify a user name and password. Your user name is the name that will appear as the first part of your email address (i.e., mary@velocityonline.net). Your user name must be all lowercase, one word (no spaces), and no more than 12 characters.
User Name

Please specify a password for this user name. Your password must be one word (no spaces), at least 4 but no more than 8 characters in length.
Password:
Please enter password again for verification:

If you require more than one email address with this account, please indicate the user name and password for each additional email needed:

If you were referred by a current Velocity Online customer, please allow us to thank them by telling us who referred you. I was referred by: