SunLink Gift Form

SunLink
The Full Service Internet Provider for Central Pennsylvania
650 Champ Avenue
P.O. Box 170
Sunbury, Pennsylvania 17801
Voice: 717-286-5764
Toll Free: 1-888-SUN-LNK-1
Fax: 717-988-3349

Please print out this form on your printer. Fill in the information and then mail or fax (If using credit card) to SunLink.

Name: _____________________________

Userid: ____________

Name for which you are requesting account time: _________________________

Userid: _____________

Number of months: ______

[ ] Netsurfer Account - $19.95 per month.

[ ] Webmaster Account - $29.95 per month.

[ ] Commercial Account - $50.00 per month.

[ ] Other - ____________________

Total: __________________

If you already pay by credit card, this amount can be applied to your credit card.

I authorize this amount to be applied to my credit card.

Signature: _________________________

If paying by check, I have included a check for the following amount: ________________

Please indicate on check: "Gift for userid" along with your userid.