Genesee Free-Net Individual Account Registration Form

(All fields marked with an asterisk (*) are required)

Current e-mail address (if you have one):

Your name:
* First Name:   MI   *Last Name:

Your home address:
* Address:
   Address:
       * City: * State: * Zip: -
Your phone:
     * Day phone: --
      Night phone: --

In the event you forget your password, we need the following information for security reasons:
     * your birth date:
     * your mother's maiden name:

I would like an individual account. Cost = $85 ($25 setup fee + $60 annual fee)


If you are applying for an account and have an address outside of Genesee County, please verify that you have a local call-in number listed on our webpage. Please note that help calls to the office will be long distance if you are located outside of Genesee County:

Operating system: PC or Mac:
I've read the Genesee Free-Net Acceptable Use Policy and agree to its terms.

Now PRINT out this completed form for mailing with your check. If you do not have a printer available, please call or write our office to request a form be mailed to you.


Next, please sign, and mail this form with proper payment (sorry, no credit cards) to:

Genesee Free-Net
5225 Exchange Drive Flint, MI 48507 810-720-2880

I have read and accept the Acceptable Use Policy and my check is enclosed for an individual Genesee Free-Net account.
 
 

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