Dasya.com Web Rental Application Form

This agreement is by and between Michael Best (Com.org Sysop) and:



 Phone number:

I have read and fully understand the service agreement available at 

 Signature and Date:


Print the account information here:

 Directory (as in http://www.dasya.com/directory/):

 User-id (for login and email):

 Password (for above user-id):

 Name (to be associated with above user-id): 

 Your current e-mail (for contact and billing):

 Domain name (if this is to be a virtual account):

 Payment (list the amount you are enclosing with this form):


Please print this form, fill it out, and mail it with your payment to:

Michael Best
907 Dimmocks Mill Rd.
Hillsborough, NC 27278