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| Your Name: | |
| Your Street Address: | |
| Your City & State/Prov./County: | |
| Your Postal Code And Country: | |
| Your Telephone Number: | |
| Your Email Address: | |
| Your Mother's Maiden Name: |
| Type Of Web Account Ordered | # Megs | # Months | Total Price |
|---|---|---|---|
| NumanFan (pricing info on previous page) | $ | ||
| NumanFan (pricing info on previous page) | $ | ||
| NumanFan (pricing info on previous page) | $ | ||
| Commercial (pricing info on previous page) | $ | ||
| Commercial (pricing info on previous page) | $ | ||
| Commercial (pricing info on previous page) | $ | ||
| Type Of Email Addresses Ordered | # Addresses | Price Per | Total Price |
| Regular Price - I am not ordering Web Hosting | $15/year | $ | |
| Reduced Price - I am ordering Web Hosting and want extra addresses (Remember, you get an allotment of free addresses with Web Hosting). |
$10/year | $ | |
| Additional Services Ordered | # Services | Price Per | Total Price |
| Domain Parking - I am not ordering Web Hosting | $36/year | $ | |
| Domain Name Registration (we register for you) | $FREE | $ | |
| Domain Name Authority Fees .COM .NET .ORG = $110/2 years, .NU = $40/year Do *NOT* remit if you are registering your own domain |
$ | $ | |
| Total Cost | $ | ||