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This is a Secure Order Form
Please complete the following information, we will need it to set up your account. 
Your new account will normally be activated within a few hours, and in any event no later than 24 hours on weekdays, 48 hours on weekends once we get approval of your credit card.  Please read the Terms of Service and Acceptable Use Policy before signing up for this service.
.Your Primary Domain Name Domain Type/ Contact
New wpix,gif.gif (112 bytes)Transfer
I will comp. transfer/reg. myself
Alternate Domain Name
Your contact email address
Select a Plan & and Payment period

Select annual payment and have your set up fee waived
General . eCommerce Options
ASP (Free ) Merchant Account Application (Free)
Ms Access $5.00/mth Real Time Transaction $895.00*
Front Page ($5.00) Secure Certificate ($175.00/year)

Real Audio $25.00/mth.(set up $30.00)

Shopping Cart $ 10.00/mth

Real Video $25.00/mth. (setup $30.00) ColdFusion $10/mth (setup $30.00)
CGI-BIN (Free)   Email boxes $5.00 each additional
Stats  $5.00/mth($ 30.00 one time charge)

Site Promotion.

Site promotion basic ($125.00) Site promotion Advanced $2500.00(annual)
Submit your site to 100+ SE and links, one URL 4 times in the year. Billing $1460.00 at order balance in 11 monthly paymnts of $140.00/mth
*    Subject to approval

Set up information all fields are necessary

Enter e-mail address required here
Password for email account desired
Forwarding address in any
Comments special instructions
Billing Information and    payment Options (select one)
Master card
Visa
Amex
Wire Transfer (request our bank details)
Check (must pay 12months) Money Order (must  Pay 12months)
Your Name as it appears on your Credit Card
Credit Card Number-if applicable
Street address.(credit card billing address)*
Expire Date
City
Telephone Number (Home)

State/province

ZIP

Telephone Number (Business)
Country
Fax Number
*must be same as the billing address of the selected credit card when payment is made by credit card

Please click only once. This form is encrypted it may take up to 60sec.to process

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