Actilon Internet

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Web Hosting Sign Up

Please complete the following form. It will be submitted to New Accounts, and an invoice for the setup fee and one year of hosting will be sent to the address provided; payment is expected via check or money order. Your web hosting account will be set up upon receipt of payment.

Company/Contractor Information
Company Name:
Address:

City:
State:
Zip:
Phone Number:
Fax Number:
E-mail Address:

Contact Information
Contact Name:
Salutation:	Mr. Mrs. Ms.
Title:
Phone Extension:

Domain Name
I wish to:	Set up a new domain Relocate an existing domain from another ISP
Desired Site:	www..com
NOTE:	If you are relocating an existing domain, it is your responsibility to transfer all files from your old ISP to Actilon Internet. We only request that the InterNIC point your domain at our servers; we will not transfer your site to our servers. It is also your responsibility to cancel your account with your previous ISP.

Plan Selection & Pricing Review Prices are in U.S. currency.
	Web Hosting Plan I One-time setup fee of $125 Recurring $20/month billed in increments of 12 months ($240) 5 e-mail addresses at your domain ($5 per additional address) 75 MB disk space 2 GB data transfer per month
	Web Hosting Plan II One-time setup fee of $150 Recurring $30/month billed in increments of 12 months ($360) 10 e-mail addresses at your domain ($5 per additional address) 150 MB disk space 5 GB data transfer per month

E-mail Addresses to Set Up
1:	@yourdomain.com POP account Forwards to
2:	@yourdomain.com POP account Forwards to
3:	@yourdomain.com POP account Forwards to
4:	@yourdomain.com POP account Forwards to
5:	@yourdomain.com POP account Forwards to

Notes/Questions/Comments