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:
WINDOWS PLANS
Plan 1	Paid Quarterly $19.95 per month Paid Annually $17.96 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):
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?	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)	Windows Plan options MS SQL 2000 MS SQL 2005 ASP ASP.NET PHP 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 Currently have certificate from another CA Items for Plan 2 and above: Real Audio/Video
	Would 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 orders) PayPal

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