WEB HOSTING ORDER FORM

Thank you for choosing ZyLink for your hosting needs. Please fill out the form below to order your web site. (Credit card payment by secure connection is available. Instructions will be provided upon completion of this form.) If you have questions, please feel free to e-mail us, or call us at 1-818-509-8579.

To begin, please choose your plan:
Plan 1	Paid Quarterly $19.95 per month Paid Annually $17.96 per month
Plan 2	Paid Quarterly $45.95 per month Paid Annually $41.36 per month
Plan 3	Paid Quarterly $69.95 per month Paid Annually $62.96 per month
Plan 4	Paid Quarterly $149.95 per month Paid Annually $134.96 per month
Your Name:
Company Name:
Address:
City:
State or Province: (Use 2 letter abbrev.)
Postal Code:
Country:
Phone number (include area code):
e-mail:
Your domain name:	WWW.
Is this domain	New Already existing
If already existing, is there a current web site?	Yes No
List any additional domains you want pointed to the same site ($25 each)
Choose a password (5-10 char)
Confirm password
Server Type	Windows NT Unix
Front Page Extensions?	Yes No
How did you hear about us?:
What Special features do you anticipate using now or in the near future?: (please do not select features you have no intention of using)	ODBC (NT) ASP (NT) Items for Plan 2 and above: Real Audio/Video SQL Telnet (UNIX) Cold Fusion (NT)
Special Instructions
Which method do you plan to use for payment?:	Check or Money Order Credit Card (Visa, Mastercard, Discover, or American Express) Wire Transfer

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