Website Hosting Sign-up

NOTE: We never sell, transfer or in anyway give out and/or divulge our clients', or perspective clients', information.

Your Company Name    
Your Name    
Your Title   (owner, CEO, President, Etc.)
Your Email Address: 

Mailing Address:

          Phone:            Fax:   

Comments/Questions:
  

I currently do not have a Domain Name Registered and I want to take advantage
of your 'No Additional Charge' service to register a Domain Name.

My first choice is
Second choice is  
Third choice is    

Sample Website Layout
" "

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I confirm that I have selected the
following Hosting Plan :

Expanded (X) ( ) $419.40 per year.

There is a 20% setup fee $83.88.

There are no Additional Hosting or Registration fees.

Please list any special offer or discount
that you qualify to receive:

You may pay just the setup fee with this sign-up form and an invoice will be sent to you for the balance.

Total Amount Paid $ with this form.

Your Satisfaction Guaranteed
If within the first 30 days you are not completely
satisfied with our service you will get
a 100% refund (less the setup fee)...
No Questions Asked.

PAYMENT

Check            (X) ( )
Money Order (X) ( )

Make Checks and/or Money Orders payable to:

WHITED SERVICES

and Mail To:

112 Mol Senia Lane - Round O, SC 29474

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You must send one copy of this form
with your Check or Money Order.

I have read and agree to the
TERMS OF SERVICE. (X) ( )

 

_______________________________________
Sign Here                               Date

Using your mouse; RIGHT click on this form.

Select 'PRINT' and then set the number
of copies (Minimum of two).

Retain a copy of this
Sign-up Form for your records!

Mail one copy to Whited Services.