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Secure Order Form

Secure Credit Card signup form for new members

Hevanet Communications - PO Box 91124 Portland, Oregon 97291
Phone: 503-531-9048

You can use this form if you want to sign up with Hevanet using a credit card. We will process your application within 24 hours of receiving it. Paying with check is also available.


By signing this contract, I understand all of the following:
That my credit card will be automatically billed on a periodic basis as a pre-payment for services to be provided the following period. (if chosen). I must notify Hevanet in writing, with 30 days advance notice of my request to discontinue this automatic charge agreement. I understand that Hevanet may continue to charge the card provided, for all fees and charges due until I change my payment method or cancel my account. Hevanet makes no warranties of any kind for the service it is providing and is not responsible for any damage I or another party may suffer. Hevanet may only be used for lawful purposes. If you want to close your account, your advanced payment will be refunded for any full months remaining on a pro-rated basis. I have read and agree to the Service Agreement.
Your Name: Type of Card:
Name on Card: Expiration Date:
Card Number:     Phone Number: 
Address: Fax  Number: 
City/State/Zip Operating System:
Preferred Email: 
(8 characters or less)
or Please respond via:
How did you hear about us: Current Email:
Comments or Special Requests
I authorize Hevanet to charge my credit card in advance for Internet dial-up access. I have checked the option I want below (check one):
Please choose Amount:
Billing Options: Just Once  Automatically Renew
How does Auto Renew work?

© Copyright 2006
Hevanet Communications
All Rights Reserved.