AFEXpress Approval Form

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Magazine"><U>LP/GAS Magazine</U></A></div> <div> <IMG SRC="04658020.gif" border=0 width="600" height="2" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> AFEXpress Approval Form</div> <div> <I><B><U>Work Order and Agreement</U></B></I></div> <div> <I>*  </I><I>Must have this information for activation</I></div> <div> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" WIDTH="665" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 30 WIDTH="154"><div> *Subscriber Name</div> </tD> <tD VALIGN=TOP WIDTH="115"><div> * Last Name</div> </tD> <tD VALIGN=TOP WIDTH="89"><div> *Username Choices</div> </tD> <tD VALIGN=TOP WIDTH="150"><div> *User's Password</div> </tD> <tD VALIGN=TOP WIDTH="117"><div> Local Dial Up #</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 44 WIDTH="154"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="44" ALIGN="bottom" WIDTH="154" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="115"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="44" ALIGN="bottom" WIDTH="115" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="89"><div> 1.</div> <bR> <div> 2.</div> </tD> <tD VALIGN=TOP WIDTH="150"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="44" ALIGN="bottom" WIDTH="150" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="117"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="44" ALIGN="bottom" WIDTH="117" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 15 WIDTH="154"><div> *Street Address</div> </tD> <tD VALIGN=TOP WIDTH="115"><div> *City</div> </tD> <tD VALIGN=TOP WIDTH="89"><div> *State</div> </tD> <tD VALIGN=TOP WIDTH="150"><div> *Zip Code</div> </tD> <tD VALIGN=TOP WIDTH="117"><div> *Telephone</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 35 WIDTH="154"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="35" ALIGN="bottom" WIDTH="154" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="115"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="35" ALIGN="bottom" WIDTH="115" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="89"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="35" ALIGN="bottom" WIDTH="89" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="150"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="35" ALIGN="bottom" WIDTH="150" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="117"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="35" ALIGN="bottom" WIDTH="117" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 15 ><NOBR><div> *Current Email Address</div> </NOBR></tD> <tD VALIGN=TOP><NOBR><div> *Fax/Beeper/Cellular</div> </NOBR></tD> <tD VALIGN=TOP><NOBR><div> *Location Type</div> </NOBR></tD> <tD VALIGN=TOP><NOBR><div> Special Instructions</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="117"><div> Service Date</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 44 WIDTH="154"><bR> <bR> <bR> </tD> <tD VALIGN=TOP WIDTH="115"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="44" ALIGN="bottom" WIDTH="115" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="89"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="44" ALIGN="bottom" WIDTH="89" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="150"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="44" ALIGN="bottom" WIDTH="150" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="117"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="44" ALIGN="bottom" WIDTH="117" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <div> <B>*SERVICE RATES</B></div> <div> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" WIDTH="668" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 30 ><NOBR><div> Subscription</div> </NOBR></tD> <tD VALIGN=TOP><NOBR><div> Monthly Cost</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="71"><div> Download Included</div> </tD> <tD VALIGN=TOP WIDTH="71"><div> Hours Included</div> </tD> <tD VALIGN=TOP WIDTH="71"><div> Additional Megabytes</div> </tD> <tD VALIGN=TOP WIDTH="71"><div> Additional Hours</div> </tD> <tD VALIGN=TOP WIDTH="71"><div> Additional Email</div> </tD> <tD VALIGN=TOP WIDTH="110"><div> Total Service Selected</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 15 WIDTH="71"><div> GOLD</div> </tD> <tD VALIGN=TOP WIDTH="71"><div> $39.99</div> </tD> <tD VALIGN=TOP WIDTH="71"><div> 500mb</div> </tD> <tD VALIGN=TOP WIDTH="71"><div> 150</div> </tD> <tD VALIGN=TOP WIDTH="71"><div> .13</div> </tD> <tD VALIGN=TOP WIDTH="71"><div> $1.25</div> </tD> <tD VALIGN=TOP WIDTH="71"><div> $.50</div> </tD> <tD VALIGN=TOP WIDTH="110"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="15" ALIGN="bottom" WIDTH="110" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 22 WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="22" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="22" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="22" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="22" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="22" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="22" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="22" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="110"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="22" ALIGN="bottom" WIDTH="110" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 25 WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="25" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="25" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="25" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="25" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="25" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="25" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="25" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="110"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="25" ALIGN="bottom" WIDTH="110" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <div> <B>*INSTALLATION RATES</B></div> <div> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" WIDTH="670" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 28 WIDTH="58"><div> Service Installed</div> </tD> <tD VALIGN=TOP WIDTH="63"><div> Install & Activation</div> </tD> <tD VALIGN=TOP WIDTH="64"><div> Additional Installation</div> </tD> <tD VALIGN=TOP WIDTH="64"><div> Additional Software</div> </tD> <tD VALIGN=TOP><NOBR><div> Reactivation</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="71"><div> Additional Equipment</div> </tD> <tD VALIGN=TOP WIDTH="71"><div> Additional Email</div> </tD> <tD VALIGN=TOP><NOBR><div> Deposit</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="101"><div> Install Total</div> <bR> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 14 WIDTH="58"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="58" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="63"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="63" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="61"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="61" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="49"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="49" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="101"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="101" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 14 WIDTH="58"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="58" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="63"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="63" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="61"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="61" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="49"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="49" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="101"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="101" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 27 ><NOBR><div> Promotion</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="63"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="27" ALIGN="bottom" WIDTH="63" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="27" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="27" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="61"><div> Invoice</div> <div> Total</div> </tD> <tD VALIGN=TOP WIDTH="71"><div> Prepaid</div> </tD> <tD VALIGN=TOP WIDTH="71"><div> Promotion</div> </tD> <tD VALIGN=TOP WIDTH="49"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="27" ALIGN="bottom" WIDTH="49" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="101"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="27" ALIGN="bottom" WIDTH="101" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 14 WIDTH="58"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="58" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="63"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="63" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="61"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="61" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="49"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="49" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="101"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="101" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 14 WIDTH="58"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="58" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="63"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="63" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="64"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="64" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="61"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="61" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="49"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="49" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="101"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="101" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <div> <B>WORK DONE</B></div> <div> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" WIDTH="669" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 14 WIDTH="178"><div> Date</div> </tD> <tD VALIGN=TOP><NOBR><div> *Satellite Modem Mac Address</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="219"><div> *Satellite Modem Serial Number</div> </tD> <tD VALIGN=TOP WIDTH="94"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="94" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 14 WIDTH="178"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="178" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="145"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="145" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="219"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="219" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="94"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="94" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 14 WIDTH="178"><div> Arrived</div> </tD> <tD VALIGN=TOP WIDTH="145"><div> Left</div> </tD> <tD VALIGN=TOP WIDTH="219"><div> User Name</div> </tD> <tD VALIGN=TOP WIDTH="94"><div> Password</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 14 WIDTH="178"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="178" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="145"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="145" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="219"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="219" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="94"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="94" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 14 WIDTH="178"><div> Installer #</div> </tD> <tD VALIGN=TOP WIDTH="145"><div> *PC Make and Model</div> </tD> <tD VALIGN=TOP WIDTH="219"><div> *Processor/Speed</div> </tD> <tD VALIGN=TOP WIDTH="94"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="94" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 14 WIDTH="178"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="178" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="145"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="145" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="219"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="219" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="94"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="bottom" WIDTH="94" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <div> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" WIDTH="670" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 30 WIDTH="71"><div> Form Of Payment</div> </tD> <tD VALIGN=TOP WIDTH="84"><div> *Space On Hard Drive</div> </tD> <tD VALIGN=TOP WIDTH="80"><div> *RAM</div> </tD> <tD VALIGN=TOP WIDTH="71"><div> *Windows Version</div> </tD> <tD VALIGN=TOP WIDTH="71"><div> Browser</div> </tD> <tD VALIGN=TOP WIDTH="246"><div> Email</div> <bR> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 15 WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="15" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="84"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="15" ALIGN="bottom" WIDTH="84" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="80"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="15" ALIGN="bottom" WIDTH="80" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="15" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="15" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="246"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="15" ALIGN="bottom" WIDTH="246" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 30 ><NOBR><div> Signal Level</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="84"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="30" ALIGN="bottom" WIDTH="84" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="80"><div> Needs New Satellite</div> </tD> <tD VALIGN=TOP WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="30" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="30" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="246"><div> Other Comments</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 21 WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="21" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="84"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="21" ALIGN="bottom" WIDTH="84" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="80"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="21" ALIGN="bottom" WIDTH="80" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="21" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="21" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="246"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="21" ALIGN="bottom" WIDTH="246" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 42 WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="42" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="84"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="42" ALIGN="bottom" WIDTH="84" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="80"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="42" ALIGN="bottom" WIDTH="80" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="42" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="42" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="246"><div> Subscriber Signed OK to Install & Documentation Form</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 45 WIDTH="71"><div> Total Payment Received</div> </tD> <tD VALIGN=TOP><NOBR><div> Demonstration </div> <div> Service</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="80"><div> Install Email Account</div> </tD> <tD VALIGN=TOP WIDTH="71"><div> Left Installation Manual</div> </tD> <tD VALIGN=TOP WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="45" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="246"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="45" ALIGN="bottom" WIDTH="246" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 21 WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="21" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="84"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="21" ALIGN="bottom" WIDTH="84" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="80"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="21" ALIGN="bottom" WIDTH="80" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="21" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="71"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="21" ALIGN="bottom" WIDTH="71" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP WIDTH="246"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="21" ALIGN="bottom" WIDTH="246" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <div> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" WIDTH="670" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 150 WIDTH="658"><div> By Signing below, I (the subscriber) understand that I am responsible for the equipment left in my possession.  I agree to purchase AFEXpress Internet access service provided by my provider.  I affirm my understanding that this agreement consists in accepting the conditions in:  1)  The AFEXpress TERMS AND CONDITIONS OF USE FORM, 2)  THIS WORKORDER, 3)  The DOCUMENTATION OF INSTALLATION and ACTIVATION OF SERVICE FORM provided to me before and after the installation of the Satellite modem and servie on my PC.  I also confirm receiving operation literature and having been given a demonstration of the service.</div> <bR> <div> *Customer Signature                                                Date</div> <bR> <bR> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 66 ><NOBR><div> A Satellite modem was installed and AFEXpress Service was installed for the subscriber as described above.</div> <bR> <div> *Installer Signature                                                    Date</div> </NOBR></tD> </tR> </TABLE></div> <div> <I>*  </I><I>Must have this information for activation</I></div> </BODY>