Hunter Point Online Internet Access Application Form Name: _______________________________________________________ Billing Address:________________________________________________ _____________________________________________________________ Day Tel:_______________ Night Tel:______________ Fax:_____________ Organization:__________________ Position:__________________________ Present Email Address:_______________@______________ (Ignore if none). System: Win 95/98/Me _____ Win 2K_____ Win XP _____ Macintosh _______ Flets Number: _________________ Activation Date: _________________ Preferred User ID: 1st choice: _______________ 2nd choice: _____________ Preferred Password: _________________ 2nd choice:___________________ The UserID and Password must contain 5-12 alpha/numeric characters. It should include at least two of the following: one CAPITAL letter, one punctuation mark or one number. Mother's Maiden Name: ______________ Your Date of Birth: ______________ Method of Payment Card Name:______________________________ Issuing Bank:_________________________ (We accept AMEX, VISA, MASTER, JCB and Cards)  Card Number:_______/_______/_______/________ Exp. Date:_____/_____/_____(myth/day/yr). Bank Transfers: Bank: Tokyo Mitsubishi Bank Account: Hunter Point Inc. Acc#: 1094175(Regular) Branch: Oji  Signature:________________________________ Date:______/_____/_____(myth/day/yr). If you are under the age of 18 you MUST have a parent or guardian sign this release form. I approve this account for the applicant and understand that (s)he agrees and is bound to Hunter Point Online User Policies. Yoshida Bldg. 3F, 1-14-16 Oji, Kita-Ward, Tokyo, 114-0002 Japan TEL: 03-5390-2545, Fax:03-5390-2539, http://www.hpo.net