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EdgeWorld Hosting Order Form

Complete the form below and fax to (949) 654-4373. Please print clearly.

PERSONAL INFORMATION

Name (first, last):__________________________________________________________

Address:_________________________________________________________________

City:________________________________ State/Province:_______________________

Postal Code:__________________ Country (if other than U.S.):____________________

Telephone:_____________________________ Email:____________________________

How did you find us? ______________________________________________________

ACCOUNT INFORMATION

Account Status (check one):

    [   ] I want to open an account with a new virtual domain name.
    [   ] I want to transfer an existing virtual domain to EdgeWorld.

Your Domain Name:

    http://www.____________________________________ Ex. http://www.yourname.com

A Login ID and Password are required when you connect to the EdgeWorld server in order to upload/download files to your site.

User Login ID:_____________________ Password:_____________________

Service Plan (check one):

    [   ] SOHO/PERSONAL at $4.95 monthly; $0.00 (FREE) initial setup fee
    [   ] ECONOMY at $9.95 monthly; $10.00 initial setup fee
    [   ] BUSINESS STARTER at $19.95 monthly; $25.00 initial setup fee
    [   ] BUSINESS PRO at $39.95 monthly; $35.00 initial setup fee

Number of Months: ________

Other:

    [   ] Check here if you would like Microsoft FrontPage 98 extensions installed.

PAYMENT INFORMATION

Payment of initial setup fee and first month of hosting is due upfront. Contracts of 6 months or more receive a discount of $10.00 off the setup fee but you must pay for 6 months of hosting upfront.

    [   ] Check
    [   ] Money Order

For Credit Card orders, please use the Online Ordering page.


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