Ivision Host

::: Hosting Order Form for Credit Card Customers

Please proceed through the order form steps below and feel free to call a ivisionhost sales associate at any time if you require assistance with your order. Required fields have an *

1.Domain Information

www.	*Domain Name	*Domain extension(s) .

	New Domain Transfer Domain I am activating a reserved Domain already registered at ivisionhost.com


Ivisionhost is a certified domain registrar. We will register your domain for $19/year (Network Solutions charges $35/year). If you choose "no" it is your responsibility to register your domain with another domain registrar and your web hosting account will not be fully functional until you do. Do you want Ivisionhost to take care of your domain registration?
	Yes No

If this is a new domain, how many years do you want to register the domain name?

2.Select Your Hosting Plan

Account Package:

Billing Cycle:

Check here if you want Microsoft FrontPage extensions loaded for this account

How did you hear about Ivision Host?


Other:
	(In order to keep our prices low, we rely on your input. Thank you! )

3.Your Contact Information

*Name (first, last):
*Company Name:
*Address:
*City:	State: Zip:
*Country:	State (if other than the U. S. or Canada):
*Phone Number:
Fax: (optional)
*E-Mail:	If you provide a free email address such as Yahoo or Hotmail, Your New Account will be rejected.

4.Your Billing Information

We do not tolerate credit card fraud, which is a felony. If it is determined that an attempted order is fraudulent, we will report all information to the FBI, at http://www.ifccfbi.gov

*Credit Card Type:

*Name on Card :

*Credit Card Number :

*Expiration Date :

*Security Code :

On the back of your credit card, there is a long series of numbers in the signature line. Please enter the LAST 3 DIGITS of that number here. On some cards like those from American Express the number is four digits and appears above and to the right of the credit card number embossed on the FRONT of the card.

*Issuing Bank :

*Bank Phone Number :

*Billing Phone Number :

*Address :
(if different from above)

5.Activate Site

Please type your full name AND email address in the box below. By doing so and submitting this form to Ivision Host you are agreeing to the terms, conditions and acceptable use policy previously set forth by Ivision Host. This is a binding document. By placing this order you are requesting service from Ivision Host, and therefore do incur all fees associated with the provisions of said service. If you are ordering a UNIX-based account you will receive your account logins within 12hours of hitting submit below.

I AGREE to all items in the terms, conditions and acceptable use policy:

*Signature: Date: