ONLINE REQUEST FORM
Call (505) 287-2159 Fax (505)287-8502 or mail@7cities.net

Please provide the following contact information:

Date

Name
Address
City,State,Zip
Organization
Work Phone
Home Phone
E-mail

Please provide the following information:

Username
Choice 1 Choice 2 Choice 3
Password Re-enter Operating System

Billing Information
Credit card
Cardholder name
Card number

Expiration date

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Additional Comments


Cibola Internet Services Contract Agreement

Please read through the Service Agreement before submitting this form. Submittal is automatic acceptance and agreement of it's full contents.

Cibola Internet Services L.L.C.
Last revised: September 08, 2000