Organization Signup

Please provide the following contact information:

Contact Name
Title
Organization
Street address
Address (cont.)
City
State/Province	Zip Code:
Country
Work Phone
Home Phone
Primary Phone	(Use main organization phone number)
FAX
E-mail
Web Site URL	(If you have a Web Site)

 

What type of computer do you use?

None Pentium Pro Pentium 386/486 (IBM/Compaq, etc.) 586/686 (IBM/Compaq, etc.) PowerPC DEC Alpha PS/2 Sun Sparc Other

What operating system do you use?

None Windows 98 Windows 95 Windows 3.x Windows NT Macintosh (System 7.x) NeXT Unix (any type) DOS Other

What type of Internet connection do you have?

None America Online CompuServe Dial-Up Modem (ISP) Dial-Up ISDN (ISP) Dedicated Modem (ISP) Dedicated ISDN (ISP) Dedicated Network GEnie Prodigy Other

Do you have e-mail?

Yes No

Describe your organization's Products & Services

Give some Historical Information about your Organization:

List the organizations primary officers, employees, or members:

Describe your organizations major achievements and/or awards:

What type of WEB service are you intersted in?
(if you want a Web Page link, make sure you filled out URL above)

New CleveNet WEB Site Link to existing Web Site E-mail Accounts Other Internet Services Consulting Help Need to Talk. Call me

If you are chosing a New CleveNet WEB Site fill out the following fields:

Choose a Domain Name (pick "your_name" for ".CleveNet.com/your_name")
Note: Short, but descriptive names are best. Subject to availability

First Choice: 
Second Choice:
Third Choice: 

Estimate number of Web Pages you might need:

Check here if you DON'T WANT organization address listed.
Check here if you DON'T WANT organization phone # listed
Check here if you DON'T WANT organization e-mail listed
Check here if you DON'T WANT personnel listed
Check here if you WANT a personal page for any employees (extra charge)
Check here if you WANT the contact person listed at the top of
   this page to be listed as the primary contact for Web pages.
      If not, please list primary contact: 

Do you want any graphics added to your Web page? Yes No

Do you have any photographs to be added to your Web? Yes No

List any additional Web or Internet needs or desires:

 

How would you rate this Web Site?

awful poor average good excellent

How did you hear about CleveNet.com?

Other InfoSeek WebCrawler Yahoo Other Search Browsing (by accident) Random Searches Cleveland Live Link Other Link Radio Advertisement Yellow Pages Newspaper Advertisement Other Advertisement Enter specific source, if possible:

Please leave any additional comments about the CleveNet Web Site: