Account Order Form

Name
Title
Organization
Address
City
State
Zip
Phone
FAX
E-mail

Type of web account desired:	Basic Web Account ($40 setup/$15 mo.) Domain Web Account ($180 setup/$30 mo.) <None>
Other services:	E-mail POP Account ($5 setup/$5 mo.)	Quantity:
	E-mail Alias ($2 setup/$2 mo.)         (requires an E-mail POP Account with us)	Quantity:
	E-mail Forwarding ($2 setup/$2 mo.)	Quantity:
	Auto-responder ($10 setup/$5 mo.)	Quantity:
	Mail Form CGI ($5 setup/$5 mo.)
	Microsoft FrontPage Support ($5 setup/$5 mo.)
	Web Site Promotion ($50 if you don't have an account with us)
	Main web page address: Web site title: Brief description: Six keywords: 1 (may be single words or two word phrases, ordered in priority, with no repeating) 2 3 4 5 6

Your desired account name: (will determine your web page address - i.e.: http://youraccountname.com or http://youraccountname.holyoak.com)
Your desired password: (must be at least 8 characters and include at least one number)
Payment period:	Monthly Quarterly Yearly <One Time Fee> (Site Promotion Only)

I have read and agree with the policies governing this account: NO YES