CALIFORNIA STATE UNIVERSITY SAN MARCOS
Academic Computing Services

Dialup Services

CSUSM Subscriber: Please print out this form and provide the following information

Full Name (Please Print): ___________________________________

CSUSM  login ID: ___________________________________

Phone (day) : ___________________________________

Date: ___________________________________

Circle one:     6 Months -- $35 (US)               1 Year --$60 (US)

Check or money order in the amount of $35 (US) or $60 (US) payable to: CSUSM IITS Dept.

Mail this form and check to:
CSUSM 
IITS

Dialup Services
San Marcos, CA  92096-0001

Or you may drop off the filled out contract and check at 
Craven Hall 2302.

For Office Use Only: Contract # ______________________

Signature: ___________________________________ Date: ___________________________________