ORDER FORM
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New Users / Returning Users
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to setup or return to your account for this form. Creating an account enables you to return to this form and your submitted results. An account will also enable you to partially complete this form and return later to finish the form. The account you establish is only for this form.
Please indicate what services you are ordering:
Website Hosting: Full Service
Yes
No
Email/List Service Services
Yes
No
SPAM Filtering Service
Yes
No
800 / Dial Up
Yes
No
T1/DS1;Bonded;T3/DS3
Yes
No
SPECIAL ORDER NOTES:
T-1 to OC3 SERVICES
*
Number of Sites
1
2
3
More than 3
SITE 1
T-1/DS3 (1.544MB)--Bonded T1/DS3 (2x1.544MB)--T-3/DS3 (3x1.544MB)--OC3 (24x1.544MB)
Enter Qty
Service Type
T1/DS1 1.544
Bonded T1 (2 x 1.544)
T3/DS3 (3 x 1.544)
OC 3 (24 x 1.544)
MOE (Metro Ether)
EOC (Ether over Copper)
Enter Amount
Quote #
Site Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip
Site Phone Number
Site Contact
Email Address to Site Contact
SITE 2
T-1/DS3 (1.544MB)--Bonded T1/DS3 (2x1.544MB)--T-3/DS3 (3x1.544MB)--OC3 (24x1.544MB)
Enter Qty
Service Type
T1/DS1 1.544
Bonded T1 (2 x 1.544)
T3/DS3 (3 x 1.544)
OC 3 (24 x 1.544)
Enter Amount
Quote #
Site Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip
Site Phone Number
Site Contact
Email Address to Site Contact
SITE 3
T-1/DS3 (1.544MB)--Bonded T1/DS3 (2x1.544MB)--T-3/DS3 (3x1.544MB)--OC3 (24x1.544MB)
Enter Qty
Service Type
T1/DS1 1.544
Bonded T1 (2 x 1.544)
T3/DS3 (3 x 1.544)
OC 3 (24 x 1.544)
Enter Amount
Quote #
Site Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip
Site Phone Number
Site Contact
Email Address to Site Contact
MORE THAN 3 LOCATIONS: ATTACH DOCUMENTS HERE
FULL SERVICE - WEB SITE HOSTING
Website Hosting
Entry Website Hosting $10.95/Month
Value Website Hosting $24.95/Month
Premier Website Hosting $39.95/Month
Enterprise Website Hosting $89.95/Month
Optional Add-on
Domain Name(s)
*
Website - Optional Add-on
$2.00 per Month per Email
$10.00 per Month per IP
$25.00 SSL Setup 1x + cost of SSL Certificate
$2.00 per Domain Alias per Month
*
Qty of Email Accts
Please indicate Email addresses (ie name1@domainname.com; name2@domainname.com; name3@domainname.com)
*
Qty of IP Addresses
*
Qty of Domain Aliases
*
Enter Domain Alias Name(s)
OTHER EMAIL SERVICES
Email Services
$25.00 Unlimited Email on your Domain
$4.95 Additional Email Address
$25.00 Mailing List Server
*
Indicate Domain Name
*
Qty of Email Accts
Please indicate Email addresses (ie name1@domainname.com; name2@domainname.com; name3@domainname.com)
Spam Filtering Services
1-10 Email Box Spam Filtering $10.00/Month
11-50 Email Box Spam Filtering $35.00/Month
51-100 Email Box Spam Filtering $70.00/Month
*
Indicate Domain Name
Dialup
Nationwide Basic Dialup Account $19.95/Month
800 Travel Dialup Account for first 55min $7.00/Month
DSL SERVICES
*
Item A
Item B
Toner, Parts, or Supply Order
*
What would you like to order?
*
Please indicate the following:
I believe this is included in my contract
I need a quote
I have a quote
*
Please let us about your quote. Who provided it and how much.
For Model # (if known)
Serial # (if known)
Copy Count (if known)
*
Indicates Response Required