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: 

Phone:  Fax:   

Comments/Questions:
  

Your Domain Name
" "

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    

I select the following Hosting Plan :

Economy  (X) ( ) $227.40 per year.

Basic        (X) ( ) $299.40 per year.

Expanded (X) ( ) $419.40 per year.

Maximum (X) ( ) $539.40 per year.

Other Plan (X) ( ) $ per year.

Please provide details of "Other Plan"

There is a 20% setup fee for each of these Hosting plans.

There are no Additional Hosting or Registration, fees for any of the above standard plans.

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

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 Money Orders payable to:

WHITED SERVICES

and Mail To:

112 Mol Senia Lane - Round O, SC 29474

Use your browser print icon to print a copy
for your records and you must send one
copy with your Check or Money Order.

Continue on down the page to the "Submit Button".

Credit Card   (X) ( ) You must complete the page.

For comments or suggestions concerning Credit Card use please contact us info@whitedservices.com

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Credit Card Information

Name of Authorized Signer

"EXACTLY AS SHOWN ON THE CARD"

Credit Card Type:
(X) MC   VISA

Credit Card Number
Expiration Date of Credit Card (00/00)
3 or 4 digit security code
(Found on the back of Visa, MC, & Discover Cards)

If your credit card statement is sent to a different address than your mailing address above.

Statement Mailing Address for the Card  
City, State, Zip: 

I authorize Whited Services to debit my card the amount shown above.

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

You should click on the print icon on your browser before you submit this form so you may retain a copy of this
Sign-up Form for your records!