Hosting Form

Innovative Computer Specialists Corp
2701 Dashwood Ave
Troy, MI 48083-4461

Print And Complete
The Information For
Web Site Hosting

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Hosting Plan Desired: ___ Basic Package          - $29.95 per month
                                       ___ Business Package    - $49.95 per month - 1 Free Domain Name
                                       ___ Corporate Package - $69.95 per month - 1 Free Domain Name
                                       ___ Enterprise Package - $89.95 per month - 1 Free Domain Name

Domain Name Registration
New Domain ( All new domains Free with all packages except Basic Package) $15.00 for New Domain for Basic Package.
www.___________________________________ . com .net .org .biz   .info   .us     (circle one)

If you have an existing domain we will send you the server information so the DNSes of your domain can be updated.

Existing Domain Name: www._____________________________________-

User ID (3-13 Characters - No Special Characters i.e., @#$%
Cannot begin or end with a numeral)

___________________________________

Password 18-25 Characters We recommend mixing letters with numerals)

___________________________________

Name

Business Name

Street

City

Phone Number

Email Address

__________________________________________________________

__________________________________________________________

__________________________________________________________

_____________________________State_______Zip Code __________

__________________________________________________________

__________________________________________________________

Check Enclosed for
Basic Package

Domain Regristration (1yr)
Three (3) Months Hosting Fee

Total Enclosed

$15.00
$89.85

$104.85 or
$89.85 Without Domain Registration

Check Enclosed for
Business Package

Free Domain Regristration (1 year)
Three (3) Months Hosting Fee

Total Enclosed

$00.00
$149.85

$149.85

Check Enclosed for
Corporate Package

Free Domain Regristration (1 year)
Three (3) Months Hosting Fee

Total Enclosed

$00.00
$209.85

$209.85

Check Enclosed for
Enterprise Package

Free Domain Regristration (1 year)
Three (3) Months Hosting Fee

Total Enclosed

$00.00
$269.85

$269.85

By Submitting this order you hereby agree with the "Terms & Conditions"
and "Accepted Content and Use" policies of Innovative Computer Specialists Corp

Home | Web Site Hosting | Web Site Development | Web Site Promotion | Specials