Web Hosting Order Form
All fields in
bold
are required.
We accept payment by check, money order, and cash.
. You must agree and keep to the terms of our
acceptable use policy
.
Name
Address
Address
City
Zip/Post Code
Country
Domain Name
(eg.
yourdomain.com
)
Is this:
(Select Correct Box)
New Domain
Domain Transfer
Current Email Address
Must be a valid email address from an ISP.
Organization/Company (If any)
Password
(Must be less than 8 charcters and contain at least 1 number)
Confirm Password
Phone
Fax
Package
Package 1 ($25.00) 25MB
Package 2 ($50.00) 50MB
Package 3 ($75.00) 75MB
Package 4 ($100.00) 100MB
Package 5 ($200.00) 250MB
Payment Option
Check
Money Order
Cash
Will be accepting credit card payments soon.
Please make out checks or money orders
PAYABLE TO
: T. LAND
MAIL TO:
11428 Monterrey Dr.
Wheaton, MD. 20902
Special Details (Not Required). Please tell us where you originally found our site if you remember.
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