Please print this page and follow mailing directions in Section (5). Select the services you wish to order. If you have any questions, please call us at (206) 251-2055.
Your domain name: www.___________________________________________________
____ Yes, please register this domain. $15.00 x ______ years = $ _____________
Please circle the Hosing Plan and Billing Cycle for the Hosting Plan you wish to purchase:
| Personal Hosting Plans | VPS Hosting Plans | ||||||
| Billing Cycle | Economy | Deluxe | Premium | Economy | Standard | Premium | |
| Monthly | $7.96 | $14.96 | $28.96 | $49.95 | $79.45 | $193.45 | |
| 12 Months | $95.52 | $179.52 | $347.52 | $599.40 | $953.40 | $2,321.40 | |
| SETUP FEE | Free | Free | Free | Free | Free | Free | |
| Business Hosting Plans | Dedicated Hosting Plans | ||||||
| Billing Cycle | Lite | Deluxe | Pro | Economy | Standard | Premium | |
| Monthly | $14.95 | $24.95 | $34.95 | $149.00 | $228.00 | $366.00 | |
| 12 Months | $161.52 | $269.52 | $377.52 | - | - | - | |
| SETUP FEE | $20.00 | $20.00 | $20.00 | Free | Free | Free | |
Your domian name: www. _____________________________________________
Please circle the Service Plan you wish to purchase:
| Site Service Plan | ||||
| Plan | Bronze | Silver | Gold | Hourly |
| Cost | $195/mo | $370/mo | $595/mo | $85/hour |
| Update Hours/Month | 2 | 4 | 6 | -- |
* Required Information
* Your Name: _________________________________________
Company Name: _______________________________________
* Address: ____________________________________________
* City, State, Zip: ______________________________________
* Daytime Phone Number: _______________________________
Fax Number: __________________________________________
* E-mail: _____________________________________________
Please provide an e-mail address below that does not use the domain name you are submitting. Or, if you only have one email address, you can use that address here too.
* Second E-mail: ______________________________________
How did you find out about us? ___________________________
Please include your check payment (made payable to On The Brink Designs) with this order form and put your domain name in the memo of your check.
Please include charges from Sections (1), (2), and (3) above. TOTAL $___________________
Please mail payment to the following address:
On The Brink Designs
PO BOX 18762
SEATTLE, WA 98118-0762
I have read and agree to On The Brink Designs’ Acceptable Use Policy (follow link on bottom of our Website).
Signature: _______________________________________________ Date: __________