EASY INTERNET SERVICES (EIS)
A Division of C.E.B. Services Inc.
56K DialUp

Order Dialup Access

Organization Name

Last Name Middle Initial First Name

Street Address City State:

Zip Code Phone () Fax ()

E-Mail Address

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Billing Information

Last Name Middle Initial First Name

Street Address City State:

Zip Code Phone () Fax ()

E-Mail Address

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Payment method: Cash Check/MO Visa Master Card Discovery
Do not mail Cash.

Card Number Expiration Date: Month Year

All Accounts will be billed monthly.