Type of order:
Web Hosting
Web Design
Graphic Design
Name:
Address:
City/State/Zip:
,
,
Phone Number (include area code):
Email Address:
Company (Optional):
Product/Service Selection:
Package Selection (web hosting only):
Personal Package
Hobby Package
Gamer's Package
Corporate Package
Simple Package #1 (5 megs)
Simple Package #2 (10 megs)
Simple Package #3 (15 megs)
Desired domain name, or if purchasing one of simple packages, give the name of the directory you wish to have:
Check this box if you already own this domain name
Optional Add-ons:
Real Audio - $8/mo
Java Chat - $12/mo (only 300meg accts)
Referrer Logs - $7/mo (optional)
Miva Merchant - $495/setup -- $45/month thereafter
Extra POP (email) Account - $12/one-time setup
Extra FTP/POP - $17/one-time setup
Extra Telnet/FTP/POP - $27/one-time setup
Setup Fee:
Internic Fee:
Monthly Fee:
Option(s) Fee (total):
Final Total:
For web and graphic design purchases:
Please enter your purchase ID number that was given to you via email:
NOTE
: To place a web or graphic design order, you must first submit an
estimate!
Credit card information:
Credit card type:
Visa
Mastercard
Amex
Credit card number and expiration date:
,
Appropriate info (email desired, passwords, etc.):
