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Sentex Residential Dial-up Application Form

Fax this application to Sentex Communications (519) 651-2215

Name:  
Company:  
Address:  

City:

   Postal Code:
PHONE   Home:

Daytime:

 Fax:

Please provide a User ID and password for the system

The User ID will make up your e-mail address and be your account name.
It may be between 3 and 16 characters in length and may contain letters and numbers.
There will be a $10.00 administration charge to change an e-mail address after initial creation.

User ID ______________________  Second Choice (just in case) ________________________
(your User ID will be ALL lower case letters)

Password _______________________ (minimum 6 characters)
Our system is case sensitive. You MUST use a mixture of letters and numbers (or mixed-case phrases).
      Please choose a package and a term
Package Hours per month Monthly Term 6 Month Term Annual Term Overage Fees per Hour
Basic 30 N/A N/A

$129.95

 $1.00
Intermediate 120 $19.95* $99.00 $179.40 $0.50
The Max! Unlimited $21.95* $119.70 $203.40 N/A
  • Dial-up packages are available for 30, 120, or unlimited hours per month.
  • Prices do not include taxes.
* The monthly payment option is only available with pre-authorized payments and can be made with Visa, MasterCard, debit card, cash, or cheque.
Please read the following before submitting the application
  • Accounts are created within 24 hours of receipt of payment and billed in advance.
  • Cancellation requires 30 days written notice.
  • Invoices (or renewal notices) arrive by email approximately 30 days before payment is due.
  • G.S.T. is required, P.S.T. is not required.
  • Cheques should be made payable to Sentex Communications.
  • Extra time, above the allotted monthly hours, will be billed based on the Overage Fees.



I have read, and agree with the terms and conditions __________________________________________.


Date: ___________________________________________.