ZiD - Internet Access Order Form

We thank you for using our on line registration form. If you have questions, you can always contact us by e-mail or phone to: (514) 990-6172 or 1-800-361-5060

Contact Information (the fields which appear in blue * must be completed)

First Name:* Last Name:* Company: Department: Address:* City:* Province:* Quebec Alberta B.C. Manitoba New Brunswick Newfoundland Nova Scotia Ontario P.E.I Nunavut Saskatchewan N.W.T. Yukon Postal Code:* - Phone:* () - Work Phone: () - Fax:  () - E-mail:

Personal Plans (residential) (select the plan by clicking on the appropriate circle)

Plan Type * 56,6 Kbps Monthly Cost Price** Include in the fixed price 56K Monthly ** $21.00 $  21.00 1 E-mail 56K 6 month** $18.33 $ 110.00 1 E-mail 56K Yearly** $ 16.66 $ 200.00 1 E-mail

* Based on an intermittent dialup and non-simultaneous connections. Each account of user should be used only for one person to Internet.     ** Paid one year in advance, by credit card or cash.

PASSWORD (min 5 / max. 12 characters)
Please choose a password for your account
Password
Password Confirmation
Requested E-mail:(ex:yourname@zid.com)@ZiD.com
Payment type (Please Note: No account will be activated before to have received the payment or an authorization of credit )
Payment type: Choice Visa. Mastercard. Certified Cheque Money Order
-Subject to standard terms and conditions standard of ZiD.com:  Click here