Application/Service Agreement for Internet Services
Print and complete form, then fax to 225.336.9743 or 800.324.2988
TelAmerica Long Distance | 263 Third Street | Suite 208 | B.R., LA 70801

Type of Service: __Business __Residential

Location: BR / LAF / NO / GON / NR / NI / OP / PLAQ / COV / SLID / SLID / KEN / Other:              

Services Requested

Internet Dial-Up Account - unlimited access
___$19.95/month (TelAmerica customers)
___$21.95/month (non TelAmerica customers)

Would you like a personal web space? (personal or noncommercial only; 2MB available with each account) __Yes __No
Do you need a web site designed for you? (hourly charges apply)  __Yes __No

Would you like to establish a domain name? (requires a $50.00 one time setup fee)  __Yes __No
If yes, please indicated name choice:_____________________________

Web Storage for Commercial Accounts
___$24.95/month + $15 initiation fee (TelAmerica customers only)**
___$34.95/month + $30 initiation fee (non TelAmerica customers)**
** This price requires that the web site is no greater than 5MB and receives no more than 9,000 hits/month. Excessive use will require an additional monthly fee,
while sites requiring more than 5MB will be charged $3/month per extra MB.

Operating System
__ Win 3.1x   __ Win 95   __Win 98   __ Win 2000   __Win NT  __Win ME  __Mac

Method of Payment
__ Internet charges to appear on current TelAmerica long distance bill (most convenient method)
__ Separate invoice for Internet service / web page storage or
__ Charge monthly by credit card (MC, VISA, American Express) - If paying with credit card, please provide information below.

Credit Card: (circle one) | Master Card  | VISA |  American Express |     Acct #_______________________
Signature Authorizing Credit Card Payment: _______________________________________
Credit Card Expiration Date: _____/_____/_____

Terms & Conditions

Thank you for accepting TelAmericaNet, the Internet Services Division of TelAmerica Long Distance, as your Internet provider. Please initiate your Internet service in the continental United States on a best effort basis. The subscriber agrees to pay all charges incurred through access of their accounts. The right to use the service is not transferable. Payment is to be made in advance. Billing begins at the same moment the account is created.

Subscriber agrees to pay TelAmericaNet 1 ½% late monthly service charge on bills rendered monthly and payable in full within 21 days. Late payment may result in termination of service. Subscriber agrees to pay reasonable attorney's fees and court costs or collection agency fees for collection of past due balances. If NOT a TelAmerica Long Distance customer, you will be subject to normal credit approval procedures. Credit card customers: the subscriber agrees to pay all billed amounts according to card issuer agreement until the subscriber cancels the service account or discontinues credit card billing.

TelAmericaNet exercises no control whatsoever over the content of the information passing through the Internet and its system. TelAmericaNet make no warranties of any kind, whether expressed or implied, for the service it is providing. TelAmericaNet also disclaims any warranty of merchantability or fitness for a particular purpose. TelAmericaNet will not be responsible for any damages you suffer. This includes loss of data resulting from delays, nondeliveries, misdeliveries, or service interruption caused by its own negligence or your errors or omissions. Use of any information obtained via TelAmericaNet and the Internet is at your own risk. TelAmericaNet specifically denies any responsibility for the accuracy or quality of information obtained through its services.

TelAmericaNet's Internet access services may only be used for lawful purposes. Transmission of any material in violation of any United States or state regulation is prohibited. This includes, but is not limited to: copyrighted material, material legally judged to be threatening or obscene, or material protected by trade secret. You agree to indemnify and hold harmless TelAmericaNet from any claims resulting from your own use of the service which damages you or another party. TelAmericaNet reserves the right to discontinue service to any customer who knowingly violates the acceptable policies of any networks to which TelAmericaNet is directly or indirectly connected. It is not acceptable to use TelAmericaNet to transmit material legally judged to be threatening, obscene, or harassing. Please read our E-mail policies.

Any access to other networks connected to TelAmericaNet and/or the Internet must comply with the rules appropriate for that other network. This specifically, but not exclusively, includes NSFNET. Use of TelAmericaNet's Internet services may be for any lawful purpose. Use of TelAmericaNet's Internet services for lawful commercial purposes is both permitted and encouraged.

A thirty (30) day written notification is required before cancellation of service. Only a written request to terminate your service relieves you of your obligation to pay the monthly account charge.

TelAmericaNet Internet access accounts are encouraged to access the Internet on a regular basis. To allow fair access for all TelAmericaNet Internet account subscribers, TelAmericaNet discourages monopolizing the use of dial-up lines. TelAmericaNet reserves the right to cancel a TelAmericaNet Internet access account subscriber immediately upon written notice if, according to our judgment, the subscriber abuses such use of the Internet access account.

These Terms and Conditions reflect the entire agreement of the parties, supersedes all previous oral or written representations, understandings, agreements and shall prevail notwithstanding any variance with terms and conditions of any order submitted. These terms and conditions shall be governed by and interpreted in accordance with the laws of the State of Louisiana, United States of America.

All customers receiving Domain name registration are responsible for paying any current fees charged by Internic/Network Solutions, which are billed directly to the customer by Internic/Network Solutions. TelAmerica bills to the customer a Domain set up fee of $50.00, unless otherwise specified.

Signing below in conjunction with the use of Internet services provided by TelAmericaNet constitutes acceptance of these Application / Service Agreement Terms and Conditions. Terms and Conditions may be amended by TelAmericaNet at any time and will be preceded by written and / or electronic mail notice to subscribers. Continued use of TelAmericaNet following such modifications constitutes acceptance of these Terms and Conditions, modified.

Please sign below after reading these Application / Service Agreement Terms and Conditions in full.

Signature___________________________________

Print Name_________________________________

Date_____________________

ACCOUNT INFORMATION - Please supply TelAmericaNet with your desired E-mail ID(s) - 2 e-mail addresses are available with each account

1^st Preferred E-mail ID _______________________

2^nd Preferred E-mail ID _______________________

Password (must be at least 5 characters and/or numerals) ________________________