Order Form

Careme's Web Hosting And Design

Our Order Form

Name:

Address:

Address(2):

City: State: Zip:

Phone: E-mail:

Packages

Package A........................................$210.00

Package B........................................$270.00

Package C........................................$320.00

Free (yourname.com) Domain name wanted:

Create You Own Package

Domain (yourname.com) $70.00..... Domain name wanted:

Free Domain (youname.cjb.net) ( 1 Banner)....http://.cjb.net

Internet Connection (NetZero) FREE

Voicmail $10.00 a month

Web Design $25.00 per page.... how many pages:

POP3 E-mail $1.00 per mail box

Web Hosting $15.00 a month

25mb Web Space $60.00

50mb Web Space $120.00

75mb Web Space $180.00

100mb Web Space $230.00

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Payment Plans

Credit Card

Name On Card:

Exp.date.

Desired User Name:(4-8 letters or numbers)

Password: (7-12 letters or numbers)

Re-Enter Password: (7-12 letters or numbers)

Money Order -or- Check

Please Send To:

Peter Careme

363 Mettacahonts Rd

Lot 9

Accord,NY 12404