RadixNet ADSL Order Form		 		800-309-5254  FAX: 301-839-0836


Name:		___________________________________________________

Service Address:___________________________________________________

		___________________________________________________

DSL Phone #:	___________________________________________________

Home Phone #:	___________________________________________________

Work Phone #:	___________________________________________________

Email Address: 	___________________________________________________

PLEASE SELECT: Pop Mail Box, New Account ( ) or Existing User ( )  and complete fields below.

Login ID Name (1st Choice): ___________________ (2nd Choice): ___________________Password: ___________________

RADIXDSL ACCESS and OPTIONS (indicate all that apply):
( ) ADSL 768K/128K			( )$ 59/Month	( )$177/Qtrly	( )$708/Yearly
DSL modem, (1)Line filter,10MB web,        $120/Setup      $120/Setup      $120/Setup
(5)Email boxes, (1)Static IP Address

Qty(  ) IP Addresses/Block of  8:	$10/Month/block
					$20/Setup/block

Qty(  ) Additional Email Boxes:		$ 5/Month/each
					$10/Setup/each

Qty(  ) Additional Line Filters:	$20/each

IF YOU HAVE A RADIXNET DIALUP ACCESS ACCOUNT THAT YOU WISH TO CANCEL AFTER  YOUR RADIXDSL CONNECTIVITY IS ESTABLISHED, 
PLEASE CONTACT RADIXNET SUPPORT AT 301-567-9831.

Payment Info:
(  ) Check (Quarterly & Yearly Payments only)	(  ) Visa		(  ) Mastercard	     (  ) Discover	

Credit Card #:___________________________________________________

Exp Date:______________  Name on Card: ___________________________________________________

Agreement/Terms and Conditions:
This is an agreement for DSL service from RadixNet (RadixDSL).  Under this agreement, the customer is responsible for 
maintaining the ordered DSL service for 1 year after the service has been installed and activated.  If the service is 
cancelled before the end of the initial 1 year term, a cancellation fee of $199 will be charged.  Timely prepayment for 
service is required.  Customers paying for monthly service are required to pay using a credit card, all customers 
paying by credit card will be automatically charged at the beginning of each period.  For an order to be placed, 
RadixNet requires full payment for the initial service period (either monthly, quarterly, or yearly) and full payment 
of the setup charges. One static IP address will be provided unless a block of (8) is purchased. Most user configurations 
leave 5-6 usable IPs from each block of 8.

I agree to the above terms and conditions and the charges associated with the  RadixDSL service.  I understand that 
RadixNet has the right to cancel my service at anytime for a violation of the RadixNet Terms of Service.  I understand 
that my service may be cancelled for non-payment, and that I may be charged the $199 termination fee in that case.  I 
also understand that I may not be able to receive the highest DSL speed offered or that service may not be available at 
my location due to line conditions or other factors out of the control of RadixNet and in this case I will receive a 
full refund.


Signature:_________________________________________________  Date:_______________

06/01/0