NCW-Online Internet Service

NCW-Online PO Box 3600 Wenatchee WA 98807


Customer Name: ________________________
Address ________________________
Address ________________________
Phone # ________________________

Service purchased: NCW-Online Fiber Optic internet service @ $__.__ per month.
Account terms: Month to Month

Setup information:
Login name: Password __________
DNS #1: DNS #2:

Email Servers: Incoming: Outgoing:
Email address #1 __________ #2 __________

Payment terms: Please read initial and sign below and mail to address on top of this form

  • Payments are due on the 1st of each month. Accounts more then 15 days past due will be suspended and Internet access will be terminated on the 15th day of the month until payment is received. If your account is placed on hold because of late payment you will be required to pay your monthly access charges in advance of the 1st of each month for the next 6. All collection fees and/or cost to recover fees owed will be paid by you the customer.

    _______  Initial here. Bandwidth usage over 10 gigabytes will be billed at $.70 per gigabyte.
    Running any kind of server such as p2p, file sharing, gaming etc is not allowed on residential internet connections and is grounds for immediate termination of service without refund of your deposit.

    _______ Initial here to signify you have read understand and agree to abide by these terms of service. NCW-Online Internet service does not extend credit. Internet access is to be paid for each month in advance. NCW-Online reserves the right to enforce this term of service on a case by case basis.

    Mail or Email must be received 5 days before end of calendar month or next months service fees will be due and payable in a pro-rated amount. If Email is used you must receive a cancellation confirmation reply from NCW-Online. Email address for cancellation - ncwonline at

    Customer signature_____________________________ Note: by signing here you the customer agree to abide by the full NCW-Online "Internet Access Agreement" policy displayed here:

    Months of service paid. ___ Date Service started ___ / ___ / ___ Amount paid $________   Check: __ Cash __ Online payment __ Network installation (Wiring) performed: Yes ____ No ____ Service install notes:_______________________________