Name
Position
Company
Address
Phone
FAX

Please send me a list of InterActive's references

Are you currently connected to the internet? Yes No

     If so, how? Single Dial-up Multiple Dial-ups ISDN Fractional T1, Frame Relay Fractional T1, SMDS Fractional T1, Clear Channel T1, Frame Relay T1, Clear Channel UUCP Other

Do you currently have an internal network? Yes No

     If so, how may workstations? 1-10 11-30 31-80 > 80

What Network Protocols are being used (check all that apply)

TCP/IP
IPX
NetBEUI
Other

Please describe your interest in internet connectivity:

For the purpose of quotation, please give the area code and
exchange for the location(s) that are to receive Internet Service:

Copyright 1998 InterActive Network Systems, Inc