NCIA - Application for Service
38 Glen Avenue, Berlin, NH 03570   Phone: 603.752.1250    Fax: 603.752.8134    office@ncia.net
NCIA Terms and Conditions
(1) NCIA exercises no control whatsoever over the content of information passing through NCIA. NCIA makes no warranties of any kind, whether expressed or implied, for the service it’s providing. NCIA also disclaims any warranty of merchant ability or fitness for a particular purpose. NCIA will not be responsible for any damages you suffer. This includes loss of data resulting from delays, non delivers, misdeliveries, or service interruptions caused by its own negligence or your errors or omissions. Use of any information obtained by NCIA is at your own risk. NCIA specifically denies any responsibility for the accuracy or quality of information obtained through its service.
(2) NCIA may only be used for lawful purposes. Transmission of any material in violation of any US or state regulation is prohibited. This includes, but not limited to: copyrighted material, material legally judged to be threatening or obscene, or material protected by trade secret. You agree to indemnify and hold NCIA harmless from any claims resulting from your use of service which damages you or another party.
(3) Any access to other networks connected to NCIA must comply with rules appropriate for that other network. This specifically, but not exclusively, includes NCIA. Use of NCIA itself may be for any lawful purpose. Use of NCIA for lawful commercial purposes is both permitted and encouraged.
(4) Connectivity is provided for your use only. Accounts are not to be shared with other individuals. Resale of direct IP connectivity to other individuals or organizations is strictly prohibited. The $20.00 account for unlimited access is not a dedicated dialup, abuse of the system will be dealt with. Each account is restricted to one single connection. Users dialing in more than once will be subject to a $1.00 connect fee for each concurrent connection setup and $1.00 per hour of each concurrent hour of usage.
(5) Accounts are in default if payment is not received within 10 days after monthly billing date. If your payment is returned to NCIA unpaid you are immediately in default and subject to a returned check charge of $15 from NCIA. Accounts unpaid 30 days after date of invoice may have their service interrupted. Such interruptions does not relieve you from the obligation to pay the monthly charge. Accounts in default are subject to an interest charge of 1.5% per month on the outstanding balance. If you default, you agree to pay NCIA its reasonable expenses, including attorney and collection agency fees, incurred in enforcing its rights under these terms and conditions.
(6) Your first month fee must be paid in advance. First month fee is non-refundable. Accounts that are activated mid-cycle will be adjusted on the next billing. Subsequent monthly billing will occur on the first week of each month, and you will be invoiced for the current month. Additional time and or services will be billed for the previous month on your monthly invoice. Service may be canceled in writing with 60 days notice without penalty. NCIA reserves the right to change the rates.
(7) These terms and conditions supersede all previous representations, understandings or agreements and shall prevail notwithstanding any variance with terms and conditions of any order submitted. Use of NCIA constitutes acceptance of these terms and conditions.

Please complete this form and sign to indicate your understanding and acceptance of these terms and conditions.
Thank you for your business and we look forward to providing you and/or your organization Internet access.

Select Type of Service
¤ Monthly Account Usage Fee-Unlimited-$20.00         ¤ Email Virus Protection-$2.00 per month

How did you hear about us?_____________________________________________
Select payment type                       Include first month fee to activate your account
¤ Cash/Check
¤ Credit Card _______________________ exp. _______ CVV2 Code: _______
Name as it appears on card ________________   Amount enclosed: _________________

Name: _____________________________ Company Name: ____________________________

Billing Address: ____________________ Town: _______________ State: ____ Zip: ________

Phone: ___________________ Fax: ___________________ SS Number ___________________

Authorized Signature: ___________________________________ Date: ___________________

Login Name: __________________________ Password: Will be assigned by NCIA
                            First Choice 16 Characters Max

Login Name: __________________________ Mothers Maiden Name: _____________________
                         Second Choice 16 Characters Max                                                                  Password Security Check
¤ Check here to receive your invoice by email
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