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Hosting Order Form
Hosting Package Selection (select one)
Bronze    monthly ($10.00)  OR yearly ($120.00)
Silver    monthly ($15.00)  OR yearly ($180.00)
Gold    monthly ($20.00)  OR yearly ($220.00 - 1 month free)
Platinum    monthly ($30.00)  OR yearly ($300.00 - 2 months free)
Platinum Plus    monthly ($50.00)  OR yearly ($500.00 - 2 months free)
   
Domain Name Information
Domain Name
Is this Domain Name ? New   Transfer
   
Account Password Information
Choose the password for your hosting account. This password will be used for ftp and cpanel access. Your password must be 5 or more characters in length, is case sensitive and can consist of letters (a-z) and numbers (0-9).
Desired Password
 
Contact / Billing Information
Name
E-Mail Address
Company or Organization Name
Address
Address 2 (if needed)
State,   
Zip
Country
Phone
Fax
AIM s/n (not required)
Yahoo s/n (not required)
   
Other Information
Comments
 
How did you hear about us ?
 
Promotional Code
   
If paying by check or money order, make payable to "I-Webz.com"
Also submit this form and mail payment to:

I-Webz.com
2004 Shenandoah Dr.
Carrollton, TX 75007

Note: Your Check or Money Order must be received before your account can be activated.
   

                                            

 

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