dbtech.net 1-800 Registration Form

Current Login Name (username) with dbtech.net that this add-on feature will be billed to.
Email:   @dbtech.net

Name      
Address  
City         
State Zip Code
Phone       
Fax   

In order to process your 1-800 registration you must complete the Credit Card information on this form or else your 1-800 service activation will be delayed or rejected.


Credit Card Information -Note: HIWAAY.net will bill the 1-800 service according to your current billing method and/or current credit card in our database. If you do not know what type of  billing method you are currently using, please email our billing department at billing@HIWAAY.net. The credit card information below will only be billed if you have defaulted on your monthly charge or if it is your current billing method. If you are currently using another Credit card which differs from the one you provide below, we will add the charges to the CURRENT card and not the one below.
Credit Card Type       
Credit Card Number 
Expiration Date         
3 digit # on back of card required for Visa / MC / Discover
4 digit # on back of American Express
Name as it appears on the card

Please Print out this form and either fax it to us at 256-650-4986 or mail it to us at  
HiWAAY Internet Services
P.O. Box 86
Huntsville, AL, 35804
By submitting this form to HIWAAY, I understand that I agree to the terms that an additional 10 cents per minute **(not including tax if applicable) will be added to my account. I also understand that charges of 10 cents per minute ** can be applied to my account in addition to the regular monthly connection fee. I authorize HIWAAY.net to authorize and bill the credit card above in case I default on my payment the total amount. I also authorize HIWAAY.net to authorize and bill my current payment method for the total amount for  the charges of 1-800 service should the card above be different from what HIWAAY.net has on file.
**RATE SUBJECT TO CHANGE WITHOUT NOTICE

________________________________      _____________________
Signature                                                       Date

dbTech will either fax or email back a confirmation of your order along with the 1-800 access number to the email or fax number you give us to us on this form.


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