Isotech ISP - Fax Order Form

Isotech, Inc.
501 Highway 169
Trimble, MO 64492

Phone: 816-370-2546
Fax: 816-370-2217

Instructions

Print form from web page
Select desired options
Mail or Fax information
Include Credit Card Number if
Faxed or Payment if sent via Mail
Activation of your website begins
upon receipt of payment and registration

Internet
Hosting
Proposal

Customer Information
Name:			Home Phone:
Company:			Work / Mobile:
Address:			Fax:
City:	State:	Zip:	E-mail:

Choice	Item	Description	Price
	IINet-127	Personal Domain Registration / One-Page Setup Fee	10.00
	IINet-118	Domain Hosting / Personal Domain Account / Monthly Fee 5 E-mail Addresses - 25 MB Web Space - Free Annual Renewal	9.95
		Annual Payment 12 months for the price of 11	109.45
	IINet-121	Business Domain Transfer Fee / One Time Fee per Domain	60.00
	IINet-301	Domain Hosting / 503c Ministry Non-Profit Domain / Annual Fee 25 E-mail Addresses - 25 MB Web Space - Free Annual Renewal	107.40
	IINet-123	Domain Hosting / Business Lite Domain Account / Monthly Fee 25 E-mail Addresses - 50 MB Web Space - Free Annual Renewal	25.00
		Annual Payment 12 months for the price of 11	275.00
	IINet-124B	Domain Hosting / Business +PLUS Domain Account / Annual Fee 100 E-mail Addresses - 700 MB Web Space - Free Shopping Cart - Free Annual Renewal	880.00
	IINet-150	Secure Server Setup	100.00
	IINet-151	Secure Certificate Setup	29.00
	IINet-152	Secure Certificate Annual Renewal Fee	125.00
	IINet-114	Dialup Account with any Web Hosting Plan / Monthly Fee	10.00
		Annual Payment 12 months for the price of 11	110.00
		Total Web Hosting Order:	_______

Questions? Contact us at 816-370-2546 or E-mail

Domain Name requested (top three choices): ______________________________________
________________________________________________________________________
________________________________________________________________________

Email Addresses Needed	Name of User

Choice	Item	Pre-paid Design Plans	Price
	SV-8400	Web Design Maintenance Hourly Rate / Changes or Updates Requested	70.00
	SV-8410	Starter 8410 / 4 Hours Design / 1 hour free consultation Basic 4-5 pages - Materials usually found on a brochure	250.00
	SV-8420	Standard 8420 / 8 Hours Design / 2 hours free consultation Up to 10 pages - External links - Photo Gallery	500.00
	SV-8430	Small Business 8430 / 15 Hours Design / 3 hours free consultation Member lists - Customer Editable Pages - Interactive Sections	1000.00
		Total Web Design Order:	_______

Web Site Required to be Operational on ______ / ______ / 2005

For Domain Transfers:
Current Domain Registrar User ID: ______________ Password: ______________

Print Name: __________________________________

Signature: ____________________________________ Date: ______ / ______ / ______

Credit Card # ________ ________ ________ ________

Card Type (circle one) MasterCard VISA Discover

Security Code (found on back) ________ Expiration Date: ________ / ________

Pay by Check: ________ Check # ________

Hosting Plans / Form Effective on 04-26-06