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:
PREMIUM LINUX PLANS
Plan 1	Paid Quarterly $12.95 per month Paid Annually $11.65 per month
Plan 2	Paid Quarterly $19.95 per month Paid Annually $17.96 per month
Gold Plan	Paid Quarterly $45.95 per month Paid Annually $41.36 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
If already existing, is there a current web site?	Yes No
List any additional domains you want to register
Choose a password (5-10 char)
Confirm password
Front Page Extensions? (select "yes" only if you you plan to publish with FrontPage software)	Yes No
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 4 PHP 5 MySQL 4.1 MySQL 5.0 Java Servlets 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) Currently have a Verisign certificate Currently have a Thawte certificate For Plan 2 and above: Shell Account
	Would you you like information on our secure Credit Card Server ($20 per month)?
Special Instructions (use this space to enter any coupon codes)
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

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