Your Name          Organization

Street       City       State

Province       Zip        Country

Email   Telephone   Fax

Please sign me up for this Account:

2 mb for $12.95 mo.            10 mb for $14.95 mo.          25 mb for $17.95 mo.

I will be sending you a CD-ROM or 3 1/2" diskettes of my Web site.
I will be uploading my Web site to your HOLDING SITE.

with this selection, I also need:

FrontPage Server Extensions (25 mb site required)        Anonymous FTP        Counter

MySQL (25mb site required)          SSL (25mb site required & $19.00 for installation)

WebMister Password Protection ($15.00 installation)  

submission of site to 2000+ search engines ($19.00 one-time fee)

Domain Name Registration:

It's a new domain name, and I will Register it*.
It's an existing domain name, please move it for me ($15.00 one-time fee).
I will  move the domain name myself*.
Reserve the domain name for me ($25.00 one-time fee**).

Credit Card Type Visa MasterCard Discover        Credit Card Number

Expiration Date (mm/yy)                     Payment Amount $

*We will supply you with Name Server Information (DNS) required for new registration and modifying
registration after we receive and approve your web site.
**You will be invoiced separately by InterNIC/Network Solutions for their $35.00 domain registration fee.