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                        ErgoNet Membership Application
 
 Send this form along with your payment made payable to "RAYMOND CAVA" to:

                                    ErgoNet
                                  PO BOX 836
                              Wildwood ,NJ 08260
 
 
  Full Name          : _____________________________________________________
 
  On-line Name       : _________________________Password:___________________
 
  Company Name I/A   : _____________________________________________________
 
  Street address     : _____________________________________________________
 
  City, state & zip  : _____________________________________________________
 
  Home Phone Number  : Area Code:__________Number:__________________________
 
  Work Phone Number  : Area Code:__________Number:__________________________
 
       I have read and agree to use this system in accordance with the
       rules as posted in the system bulletins of the ErgoNet BBS.
 
 
  Signature:________________________________  Date:_________________________
 
 
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                         ErgoNet Membership Application

All levels provide system wide access except to those areas needing special
access, such as adult areas and USENet news groups.

1 - 60 Minutes a day and Unlimited File Downloads  (1 Month)  - Cost: $ 2.50
2 - 60 Minutes a day and Unlimited File Downloads  (3 Months) - Cost: $ 7.50
3 - 60 Minutes a day and Unlimited File Downloads  (6 Months) - Cost: $15.00
4 - 60 Minutes a day and Unlimited File Downloads  (1 Year)   - Cost: $30.00

5 - 90 Minutes a day and Unlimited File Downloads  (1 Month)  - Cost: $ 3.75
6 - 90 Minutes a day and Unlimited File Downloads  (3 Months) - Cost: $11.25
7 - 90 Minutes a day and Unlimited File Downloads  (6 Months) - Cost: $22.50
8 - 90 Minutes a day and Unlimited File Downloads  (1 Year)   - Cost: $45.00

9 - 120 Minutes a day and Unlimited File Downloads (1 Month)  - Cost: $ 5.00
10- 120 Minutes a day and Unlimited File Downloads (3 Months) - Cost: $15.00
11- 120 Minutes a day and Unlimited File Downloads (6 Months) - Cost: $30.00
12- 120 Minutes a day and Unlimited File Downloads (1 Year)   - Cost: $60.00

T-Shirt - X-Large  --  $10.00 + $1.50 Shipping
          (White Shirt Hayens BEEFY-T 100% Cotton Pre-Shrunk)

T-Shirt - XX-Large --  $12.00 + $1.50 Shipping
          (ASH Shirt Hayens BEEFY-T 100% Cotton Pre-Shrunk)

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Membership Option # [  ]               Membership Option Price =  $________

T-Shirt X-Large                             Qty. ____ X $10.00 =  $________

T-Shirt XX-Large                            Qty. ____ X $12.00 =  $________

                                                     Sub Total =  $________

Shipping                                     $1.50 X Qty. ____ =  $________

Make Checks Payable to "RAYMOND CAVA"                    Total =  $________

(PLEASE DO NOT PAY BY MASTERCARD or VISA for any Order Under $20.00)
Method of payment (Circle one):  Check  MoneyOrder  Visa  Mastercard

Name on Card   : _________________________________

Number on Card : _________________________________     Expiration:_________
 
Signature      : _________________________________
 
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________________________
________________________                                             Place
________________________                                             Stamp
                                                                      Here
 
 
 
 
 
 
                            ErgoNet
                            Raymond Cava
                            PO BOX 836
                            Wildwood, NJ 08260
 
 
 
 
 
ErgoNet 01-25-94
- - - - - - - - - - - - - - - - Fold Here Second - - - - - - - - - - - - - -
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
- - - - - - - - - - - - - - - - Fold Here First - - - - - - - - - - - - - -
  How to use the built in mailer: Stack forms together with address page on
  top, then turn forms over and fold back to FOLD HERE FIRST. Then fold at
  FOLD HERE SECOND to top of form, next staple payment inside of form, tape
  or staple edges and top of form.
