Web Hosting Order Form

Hosting Services	Setup Charge	Total Cost in US$	Select Services
Starter Package
Starter Package 12 Months @ $5 a Month	$25	12 Months = $85
Starter Package 24 Months @ $5 a Month	No Setup Charge	24 Months = $120
Click for more info on our Hosting Packages

Other Services	Total Cost in US$	Select Services
Quick SSL - more info	1 year package $136
Quick SSL - more info	2 years package $227
Quick SSL Premium - more info	1 year package $169
Quick SSL Premium - more info	2 years package $288
Emails sent to Fax - more info	$2 per page + IDD Charges
Web Submission and Reciprocal Linking - more info	6 Months $180
	12 Months $300
	24 Months $480
Premium Advertising - more info	Enter your budget per month in US Currency

Administrative Contact - The hosting service would be registered with this information.
Full Name
Company Name
Address	State Zip Country
Domain Name			(No charges for Transferring existing Domain Names)
	New Domain $15 / year	Transfer Domain
Email Address			Account Setup information would be sent to this email address
Phone:		Fax:

Billing Information
Billing Name
Billing Address
State		Zip:	Country:
Payment Method	\| VISA \| Master Card \| American Express \| Cheque \| E-Gold \| PayPal
Credit Card Number				Glo-net Services is the name that would appear in your card statement.
Expiry Date	Month: Year:
Security Code		The three digit code, after the credit card number. Usually found on the reverse side of the card.
E-Gold Number				If you are paying by E-Gold, enter your E-Gold account number here.
PayPal Email				If you are paying by PayPal, enter your PayPal email address here.