Web4Agents.com Agent Website Order Form
All data entered in this form will be encrypted to protect its contents.
 

Website Owner Information

We have recorded your computer IP address as: 38.107.191.111

Company Name 
First Name
Last Name
Title
   
Street Address
City
State or Province
Postal Code
Country
   
Telephone
Fax
E-mail
Website Information
 
Requested Domain Name
Has this name already been registered?
Would you like us to register the name for you?
Select a Password
You will use this password to make changes to your account.
   
 
Billing Information
Credit Card Number
Expiration Month
Expiration Year
  cvv2
Card ID


Initial Charges

  • $31.64 Prorated current month charge
  • $35. one-month advance charge
  • $0. Set up - NO SETUP CHARGE!

                TOTAL INITIAL CHARGE = $66.64

  • If you choose to have us purchase your domain name for you, there will be an additional $18 charge for the first two-years of your domain name registration with Godaddy.com

Recurring Monthly Charges

Your credit card will be billed only $35 per month until we receive 30 days written notice of your account cancellation.

Charges will appear in the name of Webs4 Networks
   

You must download and FAX the following payment agreement to 253-449-0592 before we can activate your account. Click here to download .


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