BAM - Internet Services and Web Site Design

Online Account Signup Form

If you would like to signup with BAM for a personal or business internet access then you can use this form to submit your information. We will set up your new account and contact you with the account details shortly. You can also signup by calling our office at (519) 245-6291.

When signing up for ADSL we will first submit your phone number to ensure that you are eligible for the High Speed Internet service.

If you would like to enter this information in our secure server, please click here.

Please enter the following information:

Your full name:
Street address:	Apt.
City:
Province:
Postal Code:
Home phone number:

Please select your account type:

Unlimited Internet package for $16.95+GST per month
Starter Internet package (15 hours/month) for $10.95+GST per month
Residential ADSL package for $39.95+GST per month
Business ADSL package for $59.95+GST per month

How would you like your invoices delivered?

Electronic invoice emailed to my new email address
Paper invoice mailed to the postal address listed above

How would you like to pay for your account?

	Automatic bank withdrawal Numbers across the bottom of your cheque (Please include all numbers and spaces that appear at the bottom of your cheque)

	Please call me to confirm my bank account details.

	Pay by cheque or cash

When would you like the account activated?

Activated as soon as possible
Activated for the start of next month

What would you like your email address to be?
(Please enter a few preferences in case your first choice is already taken)

@baminternet.com is my 1st choice
@baminternet.com is my 2nd choice
@strathroyonline.com is my 3rd choice

Are there any other details?

Please email my new account details to
I am a little unfamiliar with Internet settings and I may need some help getting online

How did you hear about us? (Optional)

Friend or Relative - Name:
Yellow Pages
Advertisement
Other

Do you have any other questions or comments? (Optional)

By submitting this application you agree to the Terms and Conditions and authorize BAM to set up your new Internet account using the information listed above. You also agree that the above information is correct and if specifying credit card for payment that you have authorization to use the card according to the card holder agreement.

Thank you for choosing BAM!

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