ZyLink Order form

WEB HOSTING ORDER FORM
If you have questions, please feel free to e-mail us, or call us at 1-818-745-1048.
To begin, please choose your plan:

LINUX PLANS
Plan 1 Paid Quarterly $12.95 per month
Paid Annually $8.25 per month
Plan 2 Paid Quarterly $19.95 per month
Paid Annually $17.96 per month
WINDOWS PLANS
Plan 1 Paid Quarterly $19.95 per month
Paid Annually $8.25 per month
Plan 2 Paid Quarterly $49.95 per month
Paid Annually $44.96 per month
Gold Plan Paid Quarterly $149.95 per month
Paid Annually $134.96 per month
Your First Name:
Your Last Name:
Company Name:
Address:
City:
State or Province:
(Use 2 letter abbrev.)
Postal Code:
Country:
Phone number
(include area code):
Your e-mail:
Your domain name: WWW. 
Is this domain New
Already existing
List any additional domains you want to register
Choose a password (5-10 char)
Confirm password
How did you hear about us?:
What Special features do you anticipate using now or in the near future?:

(We use this information to determine which server to place you on. Therefore, do not select features you have no intention of using)
PHP
MySQL
  Windows Plan options
 MS SQL 2005
 MS SQL 2008

ASP
ASP.NET
  SSL (with your own certificate)
Yes
No

If you selected "Yes" do you:

Need to purchase a certificate? (we'll send you information about purchasing a certificate)
  Would you you like information on our secure Credit Card Server and ecommerce services?
Special Instructions or Requests
Which method do you plan to use for payment?: Check or Money Order
Credit Card (Visa, Mastercard, Discover, American Express or JCB)
Wire Transfer ($100 minimum order)
PayPal


If you have any problems transmitting this form, please e-mail us.