Customer Information:
Name :
First :
Middle :
Last :
Company :
Address :
P.O. Box / Street :
City :
State:
Zip:
Country :
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antarctica / Norfolk Island
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Ascension Island
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia & Herzogovina
Botswana
Brazil
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cayman Islands
Cape Verde Islands
Central African Republic
Chad
Chile
China (PRC)
Colombia
Commonwealth of the Northern Mariana Islands
Comoros / Mayotte Island
Congo
Congo, Dem. Rep. of (former Zaire)
Cook Islands
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Diego Garcia
Djibouti
Domincan Republic
Dominica
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faeroe Islands
Falkland Islands
Fiji Islands
Finland
France
French Guiana
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea (PRP)
Guinea-Bissau
Guyana
Haiti
Hawaii
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast (Côte d`Ivoire)
Jamaica
Japan
Jordan
Kenya
Kiribati
Korea (North)
Korea (South)
Kuwait
Kyrgyz Republic
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali Republic
Malta
Marshall Islands
Martinique / French Antilles
Mauritania
Mauritius
Mexico
Micronesia (Federal States of)
Midway Island / Wake Island
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles / Curaçao
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Puerto Rico
Poland
Portugal
Qatar
Réunion Island
Romania
Russian Federation
Rwanda
Saint Kitts and Nevis
San Marino
São Tomé and Principe
Saudi Arabia
Senegal
Seychelles Islands
Sierra Leone
Singapore
Slovak Republic
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
St. Helena
St. Lucia
St. Pierre / Miquelon
St. Vincent & Grenadines
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga Islands
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks & Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
US Virgin Islands
Uzbekistan
Vanuatu
Venezuela
Vietnam
Wallis and Futuna Islands
Western Samoa
Yemen
Yugoslavia
Zambia
Zimbabwe
Phone :
Residence :
(
)
Business :
(
)
ext.
Plan Information:
DockPoint Basic account is billed $10.00 monthly
1 Email Address
Business Hours Support for Connectivity Only
Web-based and Email Support
Web based SmartMail (access from any Internet connection)
Email Virus Protection
Spam Protection
QwickPop 6X Web Accelerator
Credit, Debit, Check or Cash Payments
Unlimited Access
Over 33,000 Access Numbers
Pop-Up Blocker
Dialer Software
IM Compatible
Other accounts are available and are located at http://www.dockpoint.com.
Your Login Name and Password will also be your E-mail address,(example@dockpoint.net).
E-mail addresses may take up to 12 hours to complete and be useable.
QuickPop 6x Web Accelerator username and password will be sent via E-mail upon your request. Remember To download your dialer software, just point your browser to http://www.dockpoint.com/dialerinstruct.html and follow the instructions.
Please enter the Login Name and Password you would like for your new DockPoint account. Your Login Name and Password must be at least 4 but no more than 20 characters, includes letters or numbers. (case sensitive)
Login Name :
Password :
Promotion Code : No Promotion codes available.
Payment Information:
Payments made with Credit or Debit Card allows your account to be active upon completion.
Credit or Debit Card:
Card Number :
Exp :
January
February
March
April
May
June
July
August
September
October
November
December
2007
2008
2009
2010
2011
2012
2013
2014
2015
Zip :
Check or Cash:
Payments to be made by Check or Cash must be recieved before service will begin.
Please contact DockPoint and our billing department will be glad to help you.
CVV stands for Card Verification Value. It is a 3 or 4 digit number located as shown on the pictures below.
That is the number you have to enter. If your card does not have this value at all, please enter
NO
or if it is illegible, please enter
I L
.