Direct Internet AccessSign up


Complete the form below if you wish to mail in your payment.  There is a one time $25 set up fee for all mailed in invoices. The $25 set up fee is waived if you pay by Visa, MasterCard, American Express, Discover or have the charges electronically drafted from your checking account each month. To choose one of these options and have your $25 set up fee waived click here. To mail in your payment each month complete the form below.

Full Name
Address
City
Zip/Postal code
Contact area code & telephone Number
Current e-mail address to send confirmation
Requested e-mail user name 1st choice (4 to 8 alpha-numeric characters)
Requested e-mail user name 2nd choice (4 to 8 alpha-numeric characters)
Requested e-mail user name 3rd choice (4 to 8 alpha-numeric characters)
Password (6 to 8 alpha-numeric characters)
Re-enter Password to Confirm (6 to 8 alpha-numeric characters)
 
 

 

Any special instructions or requests? (optional) 
 

 

  How did you hear about us? (optional)

After completing the form above print this page by pressing the "Control" key and the "P" key at the same time or select "Print" from your browsers menu above.

Mail your payment to:   Direct Internet Access, P.O. Box 7263, Monroe, LA 71211

Your account will be activated and you will be contacted as soon as we receive your payment.

 


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