Widener University Personal Internet Service

<%@ Language=JavaScript %> Widener University Personal Internet Service - Online Sign Up Form

Personal Internet Service
Online Sign Up Form

Welcome to the Widener University Personal Internet Service Online Sign Up Form. Widener brings you this service in conjunction with SNiP Internet.

Please fill out the information below to register for a Personal Dial-Up Internet Account.

You will receive your start-up kit in the mail within 5 business days after your payment is received or your credit card is validated.

Your Name:
Address
City:
State :
Zip Code:
Telephone:
Modem Phone:
Check this box if you do not have a separate phone line for your computer
Student/Employee Number:

In the following fields, please enter your choice for a USERNAME and and Alternate USERNAME in case your first choice is taken. Please choose something unique and personal. Your USERNAME is the name you'll use to log into our system and it will also be your E-Mail address. Your USERNAME must be at least 3 characters long but not more then 15.

Select a Username:

Select an Alternate Username:

Personal Accounts include up to two additional E-Mail accounts. These accounts are used while dialed into the main account. These
usernames can not be used to dial into SNiP. If you do not wish to use the extra accounts, please leave this section blank.

Second E-mail Username:

Second E-mail Alternate Username:

Third E-mail Username:

Third E-mail Alternate Username:

Operating System:

Do you have a CD ROM Drive?

Modem Speed: Internal External

Who is your current Internet Service Provider?

If you have questions about pricing, please take a look at our "Personal Dial-Up Accounts Pricing" page.

Membership Plan Desired:

Type of CC:

Credit Card Number:

Expiration Date

Month:

Year:

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