Dasya.com Web Rental Application Form

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


 Name:


 Address:



 Phone number:

I have read and fully understand the service agreement available at 
http://www.dasya.com/rentagre.txt.


 Signature and Date:

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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):

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

Michael Best
907 Dimmocks Mill Rd.
Hillsborough, NC 27278
USA