ComptonMedia.Com Hosting Services Online Order Form


Hosting Service Plan Options
Please Select Your Desired Hosting Plan From The Menu Below:
Contact Information:
Complete/Full Name
Current Email (No free boxes)
Street Address Line 1
Street Address Line 2
City
State, Zip code
Country
Home Phone	-
Employer
Work Phone	-
Billing Preference and Information

Check Box if Billing Information is the Same As Above
Last Name
First Name
Street address
Address (cont.)
City
State, Zip code
Home Contact Phone	-
Company Name
Work Contact Phone	-
PayPal Account Information

PayPal Account

Login and Site Preferences
Username (Choice One)
Username (Choice Two)
Password
Confirm Password
Name of your Domain (www.yourdomain.com)
Do we need to register your domain for you:
Service Agreement

Do you understand the service agreement and agree to abide by it's terms?
	Yes, I have read and I agree to the terms.
	No, I Disagree.
You will be emailed with a list of name servers and instructions how to point your site to its new hosting location.
Other Helpful Information
Use this box for anything you may need to let us know, or ask us...

Electronic Signature