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Speed Test


	Wireless available in West Plains and also Pomona click on links below for coverage starting at $29.95 call 256-3848 Click here to see coverage area West Plains Click here to see coverage area Pomona

Townsqr Internet Registration Contract

Date:

Indicate Account Type
other amount:

How do you wish to receive your Bill?

Operating System
(if you select Macintosh please indicate Version of MAC/os)

Have you previously been a Town Square Internet Client?   Yes No If yes what was your user ID

Requested User ID:
(This will be your primary Townsqr email address. Can be letters and/or numbers, no symbols)

Password:
(This can be letters and/or numbers- case sensitive)

Billing Information

Name:

Billing Address:

City:             State:             Zip Code:

Phone Number:    Work:         Home:

2nd e-mail address request:
(This is a secondary email address only. Can be letters and/or numbers, no symbols.)

2nd e-mail password:
(This can be letters and/or numbers- case sensitive)

The following information is required in case you should lose your password. It will allow us to verify your identity.

Mother's Maiden Name:
User's Date of Birth:

Payment Terms

Credit Card Type:

Visa    Master Card

Credit Card Number         Expire Date

Card Holders Name

By submitting this page I agree with all the terms and rules in the user agreement and agree to abide by those rules and provisions setforth in the

TOWNSQR USER AGREEMENT found on the previous page. I also confirm that I am 18 years of age or older.