Internet Access Account Application

ACCOUNT INFORMATION

Your username becomes part of your email address, therefore we suggest you use the first initial of your first name plus your lastname, up to a total of 8 characters. Your password MUST be at least 6 characters long, must contain at least 1 digit and have both upper and lower case letters.

Be aware that if your requested username is already in use you will be assigned one by tri.net staff.
If you do not specify a password, We will assign your initial account password and advise you of it via telephone or mail.

BILLING INFORMATION (We invoice only via email.)
Name (print): __________________________________________________
Email: ________________________________________________________
Address: ___________________________ City, State ZIP _____________________
Telephone # Daytime __________________Evening ____________________

I have read the Terms and Conditions and Acceptable Use policy applying to Tri-Rivers Internet and agree to abide by them.
I further certify that I am at least 18 years of age or am the Legal Guardian/Authorized Agent for the above named entity and authorize Tri-Rivers Internet to provide an internet access account to them.

Authorized Signature: _________________________________           Date:_____________________
Name (print): _________________________________________________