Contractor Info *TR Rep Name: Date: Phone Number: *Email Address: URL Registration Does your client need a URL (Web Address)? YES NO Please CLICK HERE to check if the URL you want is available. The URL I want is www. . com net How many years would you like to register your URL for? ($21.00 year) Would you like to register additional URLs? YES NO If you answered yes, please check if they are available and add them to the notes at the bottom of the form. Website Hosting What URL do you want hosted? www. . com net org other Please check the hosting package you would like below: Silver Plan: Up to 1000 Megs of space for $25.95 per month (includes up to 200 e-mail boxes) E-Commerce Plan: Up to 750 Megs of space for $29.95 per month, ShopSite Starter Shopping Cart (includes 100 email boxe) Value Pack Hosting: $60/mo. Includes: hosting, optimization & tracking, 4 hrs/yr. changes Approximately how many email boxes would you like set up? The following Client Contact Information MUST be filled out Completely *Company Name: *Contact Name: *Address (NO P.O. BOXES): *City: *State: *Zip Code: *Phone#: *Fax#: *E-mail Address: Paying By Check: Paying By Credit Card: Visa Mastercard Amex Credit Card #: Security #: ( Master Card, Visa - 3 Digits/ Amex - 4 Digits) Expiration Date : January February March April May June July August September October November December year (ie. 2005) Notes *Some fields are required to submit this form. B2B now accepts Visa, Master Card and American Express
B2B 
B2B
