:: SupraLink Solutions :: Online Subscription

:: Online Subscription — Web Hosting

Web Hosting Services
Please fill in the following form to subscribe to Web Hosting Services with SupraLink Solutions. Your request will be treated by our automated system. We will immediately proceed to the validation of your credit card or will wait for the arrival of your cheque. Colored fields are mandatory and therefore must be filled because an incomplete subscription will not be treated. If you have any questions regarding this form, please do not hesitate to call us at 514.906.1536. A technical advisor will answer you cordially.

General Information

Title
First Name
Last Name
Company Name
Address

City
Province
Country
Postal Code
Telephone
Fax
Reference

Information and Contract Duration

Contract Duration
	This Contract is automatically renewed at its anniversary date, unless a notice is received at our office one month before this date.

Hosting Plan
Billing Frequency

Technical Information

Web Site
FTP Site

	Username and Password

	First choice	Second choice

	Password	Third choice


	Email addresses included in your plan

	Email	Password
Email 1
Email 2
Email 3
Email 4
Email 5
Email 6
Email 7
Email 8
Email 9
Email 10

	Notes

	Specify information for any additional email address that you want in the text box above. Also, you should indicate your needs concerning the redirection of your site, redirection of emails, CGI-BIN access for Web-based applications, FrontPage extensions and additional storage space.

Method of payment

	Credit Card information

Type of Credit Card
	MasterCard offers the fastest treatment. However, if you choose the Direct Withdrawal option, you must fill the Payor's Pre-Authorization Form to this effect and fax it to us. A Word and PDF versions of this document are also available.

Credit Card Holder
Credit Card Number
Expiration Date

	Cheque Information

Cheque Number
Cheque Date

	Please note that your account will be activated upon the validation of your credit card or the reception of your cheque. If you pay by cheque, please send it to the order of the following. SupraLink Solutions Internet Solutions Provider 7375 Saint-André Street Montréal, Québec Canada H2R 2P6

Acceptation

	By clicking this Send button, I agree to the terms and conditions which I have carefully read. Furthermore, I agree to allow my credit card account to be debited. I am aware that my payment is NON-REFUNDABLE.