Name:________________________ Dated:___/___/___ Signed :___________________

I am a member of the _____________________________________________ Credit Union

Address:___________________________________________________________________

___________________________________ Barbados ID #_________________________

Phone - work:______________________ home:__________________________________

Monthly Internet Access at $55

Please initial the following points to indicate that you understand and agree to the terms of this offer.

_____ I agree to abide by the terms and conditions of the Cariaccess Terms of Service.

These are available on our web site at www.cariacces.com

_____ My bill will be emailed to me at my Cariaccess email address, along with update newsletters

Logon and email name:_________________ @ cariaccess.com Password:_____________________

For Office Use: received on ____/____/____ entered by _______

Cariaccess Communications Ltd. , Palm Plaza, Wildey, Barbados

Contact: Tel#: (246) 430-7435 Fax#: (246) 431-0170 www.cariaccess.com