Advanced Hosting Plan Order - Credit Card Form

Annexa - Bringing you and the web together

Advanced Hosting Plan Order Form

Use the form below for monthly credit card payment

You may also prepay annually by credit card, check or money order. All non-profit accounts are prepaid annually by check or credit card. If you prefer to pay by check or money order, mail it to the address on the left. Please use the prepayment link below for credit card payments.

To prepay by C.C. click this link

Monthly Billing form

Advanced Hosting	Billed at $18.95/Mo. to your credit card
	New / Renew Domain registration $15.00/Yr. (TOS agreement required) (Check the box if you need us to register or renew your domain)
Domain Name	(The name you have or want to register)
Login Name	(lower case name, used to login and as your default email account)
Password	(Enter a password longer than 4 characters, 6-10 recommended)
Credit Card
First Name
Last Name
Address
City
State
Zip
Country
Phone
e-mail
Click to enter your credit card number You will receive confirmation of your order by email.

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