Email Hosting Order Form

1 Basic Shared Hosting Information

2 Contact & Billing Information

Email Hosting
Domain Name*

Primary Domain Name i.e. mywebsite.com. Only one per hosting account. Do not include “http://www”.
Domain Name Registration
- New Registration (Buying a New Domain)
- Transfer (Transfer your existing Domain)
Additional Email Accounts

Price: $1.00

Quantity:
Email Accounts

List up to 25 email accounts.
Notes/Comments

List any additional email accounts you need.

Name*

First

Last
Business Name
Address*

Street Address

Address Line 2

City

State

ZIP Code
Phone*
Email*
Billing Method
- Invoice
- Mastercard
- Visa
- American Express
Note: Hosting charges are billed in advance and then every quarter.
Credit Card Number

Last 4 Digits
Note: If paying with a credit card, please call within 24 hours of submitting your order to provide your full credit card number.
CC Exp. Date

MM/YYYY
Name on Credit Card*

First

Last
Agreements*
- I agree to SiteVision, Inc.’s Terms and Conditions
- I agree to SiteVision, Inc.’s Acceptable Use Policy
- I agree to SiteVision, Inc.’s Service Level Agreement (SLA)
Total
$0.00

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