Pay by Check / Money Order Form

This form can be used for both new accounts and existing accounts who choose to pay by check or money order.

Please print this form, fill it out and mail it in. Allow 1-2 weeks for account to be updated. If an existing customer you will be notified through your Copper.Net email of receipt of payment. If you are a new customer, we will call you at the phone number you provide upon receipt of this form.

Please check one:
I am an existing customer ____
I am signing up for a new account ____

Please check one:
Monthly Account ____($11.95) Annual Account ____($99.00) Annual HiSpeed Account ____($159.00)

Name_____________________________________________

Address___________________________________________

City, ST, Zip________________________________________

Telephone Number __________________________________
(This will only be used to contact you if there is a problem with your payment or setting up your account)

User-id on Copper.Net_______________________
(New users: fill in the username that you would like; this will be the
first part of your email address "userid"@copper.net)

Second choice of user-id on Copper.Net_______________________
(For new accounts only)

Password on Copper.Net ____________________
(new users: fill in the password that you would like)

How did you hear about Copper.net? _______________________________

If you have a promotional code, please write it here: ____________________

For a year of access, enclose a check for $99.00 **Please note, if planning to pay monthly by check / money order, the rate is $19.95 per month**

If you need to pay monthly, we suggest using either a credit card or debit card to do so. Both card options are billed at the $9.95 per month rate and allow you instant access upon verification of the card. If you choose this option. you may sign up today at www.copper.net, or by calling us at (888) 336-3318.

You will receive a renewal notice in the mail when your subscription nears expiration each month or next year. At that time you may send another check or money order to renew your subscription.

Please mail to:
Copper.Net
Pay by Check Dept.
PO Box 511
Mount Vernon, OH 43050

Please view our Terms of Service with any questions.