Hosting Sign Up Form - VISion Interactive Systems

Thanks for your interest in Vision Interactive Systems services! Please fill in your information below:

NOTE: Prices are in US dollars. Payment by Check, Visa, MasterCard, Discover or AMEX required before the account can be setup!

Customer Information

Name:
Company/Organization:
Address1:
Address2:
City:
State/Province:
Postal/ZIP Code:
Country:
Phone:	Ext:
FAX:
e-Mail Address:
How did you find us?:	If other, please specify:

Account Information
NO ADULT, WAREZ or MP3 Sites!

Web Hosting Package:
Platform:	NT Only!
FrontPage Extensions:
Password:	*Case Sensitive!!!
Password (Verify):

Domain Information

To check if your domain name is available click here.

If this is a new domain you would like us to register, and you would like separate company/info, administrative and billing contacts, click here.

Domain Name:
Is it a Transfer?:	No, it is a new domain. Please register for me. Yes (please send transfer information)

Billing Cycle:
Basic Plans are billed semi-annually, all others are quarterly.

Payment Method:
A credit card is preferred and will allow your account to be set up quickly:

Credit Card (VISA, MC, Discover, AMEX)- Secure Online Form
Credit Card (VISA, MC, Discover, AMEX)- Fax CC Info
PayPal
Personal or Bank Check

If paying by check, please make the check payable to Vision Interactive Systems and remit to:

Vision Interactive Systems
32 O'Brien Ave
Apalachin, NY 13732-3726

Please type your full name AND email address in the box below. By doing so and submitting this form to Vision Interactive Systems you are agreeing to the terms, conditions and acceptable use policy and service level agreement previously set forth by Vision Interactive Systems. This is a binding document. By placing this order you are requesting service from Vision Interactive Systems, and therefore do incur all fees associated with the provisions of said service.

I AGREE to all items in the terms, conditions and acceptable use policy:

Additional Comments:

A link to a secure payment form will follow. You will be able to enter your credit card information there.

New Domain Registration Information (Optional)

Organization Information:

Use my information above
Use below information

Organization Name:
Organization Address:
City:
State/Province:
Zip/Postal Code:
Country:

Administrative Contact:

Use my information above
Use my assigned NIC handle
Use below information

Name (last, first):
Type of Contact:	Individual Role Account
Organization:
Street Address:
City:
State/Province:
Zip/Postal Code:
Country:
Phone Number:
Fax Number:
E-Mail:

Billing Contact:

Use my information above
Use assigned NIC handle
Use administrative contact information
Use below information

Name (last, first):
Type of Contact:	Individual Role Account
Organization:
Street Address:
City:
State/Province:
Zip/Postal Code:
Country:
Phone Number:
Fax Number:
E-Mail:

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