- Providing local internet service to Bond, Clinton, Madison, Marion, St. Clair, & Washington counties!!!!!!!!!!!

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NEW CUSTOMER INFORMATION FORM:
Mail this form to TechDoctors, PO Box 388, St. Rose, IL 62230

Name: ______________________________________________________________
Company Name: ______________________________________________________
Billing Address: _______________________________________________________
City, State, Zip: ______________________________________________________
Home Phone: ___________________ Work: ________________ Fax: ___________

Desired Login Name: __  __  __  __  __  __  __  __
Your Login Name can be up to 12 lowercase characters containing no punctuation or symbols.
Password: __  __  __  __  __  __  __  __
Your Password can be up to 12 characters containing lower case letters or numbers only.

PapaDocs Internet Dial Up Account Types:

Billing Information

If you are paying monthly, payments must be made on or before the 1^st of each month. If payment is not received by the 10^th, a $5.00 late fee is automatically applied and you will be sent a statement.  If payment is not received by the 30^th the account will be disconnected and a $15.00 reconnection fee will be assessed.  All monthly billing reminders are sent out through email.  If you choose to use an email address other than Papadocs Email, please provide us with the email address that you check often.
It is the customer responsibility to notify us if cancellation of service is requested.  Cancellation will be accepted in writing by email to service@papadocs.com, or by postal mail to PO Box 388 St. Rose, IL 62230.   Cancellation request notice must be received prior to the 1^st of the month, or the customer will be invoiced for the full month.   There is a $25.00 service fee for any check not honored by their bank. E-Village, Inc is not responsible for charges associated with local telephone companies concerning Internet accounts. 

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Please charge my credit card Visa Card Number _________________________________ Exp. Date ________ MC  Card Holder _________________________________ Discover  Signature _________________________________

I will read and acknowledge the Internet Access Agreement on the Electronic Village’s web page have 7 days to cancel this contract. (all prices and policies subject to change daily) Signature: ______________________________ Date: ______________________ Referred by: _______________________ Previous Provider: _________________

*6 month and 1 year contracts are non-refundable.