Kermode Net Inc.
4722 Lakelse Avenue, Terrace, B.C.  V8G 1R6
Telephone:  250-635-3444  Fax:  250-635-9727

REGISTRATION FORM

BILLING INFORMATION

       Name:___________________    Telephone (res):_____________
    Address:___________________   Telephone (work):_____________
       City:___________________		       Fax:_____________
Postal Code:___________________		     Email:_____________

USER ID: (usually your first initial followed by surname, all in
	 lower case)

First Choice:_________________	 Second Choice:_________________

MEMBERSHIP PACKAGES:

   Package includes:
	A $20.00, one-time, fee for account setup and maintenance.
	Free shareware software needed to get Internet ready.
	A $30.00 Optional on-site installation, if your system meets all
	   minimum requirements listed below.
	No minimum monthly connect fee.
	No connect time limit.
	Your choice of one of the following hourly blocks or monthly fees (must be prepaid):
	   __ 30 hour block @ $60.00  
	   __ 60 hour block @ $90.00   
	   __ 120 hour block @ $150.00
	   __ 100 hours per month @ $28.95 per month
	   __ 200 hours per month @ $55.00 per month
       __ 300 hours per month @ $80.00 per month
	   __ 100 hours per month for 3 months @ $70.00 per quarter
           __ Additional Email Accounts @ $10.00 each

	NOTE: GST and PST must be added to all amounts above.
	      Please make cheques payable to RGS Internet Services

MINIMUM SYSTEM REQUIREMENTS: (For on-site installation at no extra
			     charge.)

   Your computer should be at least a 386DX with 8MB of RAM 
   and 20MB of free hard drive space.  You should be using
   either Windows Program Manager or Windows 95 Desktop as
   the main operating shell.  If you are using any other operating
   shell (ie OS/2, MS Bob, Tabworks, etc.) we will have to charge
   $65.00/hr for setup assistance site time.

OPERATING SYSTEM: Windows __3.1x  __95  __Mac  __Other:__________

MODEM:	Speed:	__9600     __14400      __28800 or 33600
	What are you currently using your modem for?_____________

PAYMENT OPTIONS:    __Cash    __Cheque    __Mastercard    __Visa

AUTHORIZATION (Only for credit card payments)

   Kermode Net Inc Account Holder
   I, the undersigned, do hereby authorize RGS Internet Services
   to bill my credit card directly for online charges and
   membership fees.  Credit card billings will be processed one
   day prior to the start of service and on the same day of each
   subsequent month.

    Signature:_______________________  Current Date:____________
  Card Number:_______________________
 Name on Card:_______________________   Expiry Date:____________

Mail to:  Kermode Net Inc.     	  Fax to:  Kermode Net Inc.
	  4722 Lakelse Avenue		   Attn:  Olene Moi
	  Terrace, B.C.			   250-635-9727
	  V8G 2R1
	  Attn:  Olene Moi


ACCEPTABLE USE POLICY AGREEMENT:

   I,_________________________(username)agree to use my
   Kermode.Net account in accordance with the attached acceptable
   use policy.  I realize that failure to do so may result in the
   immediate termination of my Kermode.Net access privileges.

   Signed:___________________________	  Date:__________________

FOR INTERNAL USE ONLY

 Receive Date:__________________  Amount Received:_______________

 Process Date:__________________	  User Id:_______________

Email Address:__________________	 Password:_______________

 Processed By:__________________     Second Email:_______________

                                         Password:_______________


		(c) 1999 Kermode Net Inc.