Servicio Radiante aka " El Aleman ", Mulegé, authorized Agent ICANet  Sign up sheet, all * must be filled in  (datos para alta "dail up")  

Name *                 Nombre	__________________
Company              Empresa	__________________
Phone #   *            Telefono	__________________
Tax ID                  RFC	__________________
Address  *            Direccion	__________________
District                 Colonia	__________________
City   *                  Ciudad	__________________
Computer*            Computadora	IBM/IBM Clone ____       Macintosh ____
Login  name *       Login	__________________
Password   *	__________________you can change that later
E-mail   *	[email protected]         ([email protected])
from   *                  Inicio	month/mes                      day/dia                year/año
to   *                 Vence	month/mes                      day/dia                year/año
Method of pay   *  Pago	monthly/mensual                 6 for 5/ 5x6             units/unete
setup fee, Tax         Concepto	setup                   subsciption                       10% Tax/IVA
Total to pay            Total	__________________
Please sign me up for ICANet	Sign here_______________________________Su Firma

fill out form, print out, and send with check to 677 "G" Street, Chula Vista, Ca.  91910-3434 or bring with you to the store in Mulegé. please use browser Back to return       E-Mail