Affordable Web Hosting Service Order Form

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PART 1: HOSTING PLANS E-Mail only Hosting (no website hosting)- Includes 15 POP3 e-mail accounts Additional 5 accounts ($5 per month) Qty:  x 5 accounts Basic Hosting Plan - $10/month: - 50 MB storage - 2 GB data transfers - 10 POP3 e-mail accounts Standard Hosting Plan - $20/month: - 150 MB storage - 6 GB data transfers - 20 POP3 e-mail accounts MS Access Database Hosting Plan -$35.00 - 200 MB storage - 10 GB data transfers - 30 POP3 e-mail accounts MS SQL Server Database Hosting Plan - $50.00: (supporting (ASP) Active Server Pages) - 250 MB storage - 15 GB data transfers - 40 POP3 e-mail accounts TLM Hosting Plan -$100.00 - 400 MB storage - 15 GB data transfers - 40 POP3 e-mail accounts - One time set up fee of $175.00 Select Hosting Options (does not apply to Basic Plan): - I need Front Page extensions to publish my site: Yes - I need Microsoft .Net components for this site: Yes 1A. Template Website Design: $599.00 setup, $10.00 per month hosting. Template Website Design - Customized to fit your company's needs. 1B. E-Commerce/Online Store Hosting: $495.00 setup, $35.00 per month hosting. Shopping Cart - configured and managed by user 1C. E-Newsletter Service: Contact Us if you will have over 25,000 subscribers. 0 - 50 Subscribers, $10 Monthly Fee 51 - 500 Subscribers, $15 Monthly Fee 501 - 2,500 Subscribers, $30 Monthly Fee 2,501 - 5,000 Subscribers, $50 Monthly Fee 5,001 - 10,000 Subscribers, $75 Monthly Fee 10,001 - 25,000 Subscribers, $150 Monthly Fee 1D. Web Based Calendar: $100.00 setup, $5.00 per month hosting. Web Based Calendar - configured and managed by user 1E. Additional Hosting Services: Qty MB Additional Disk Space for Hosting Account $10.00 per additional 100 MB per month Managed Spam & Virus Filtering Service Click here for details and pricing Access to Secure Server (SSL) Required FREE for hosted sites (Standard Plan or greater) 1F. Server Co-Location - $250.00/month - FREE Setup: Total number of Servers:

PART 2: DOMAIN NAMES Important - Please Note: At least one registered domain name is required to host your web site. If you have not registered a domain name yet, we can take care of that for you. Primary Web Site Domain Name: www. Additional Web Site Domain Name Aliases: List 1 domain name on each line for any domain name aliases that will be pointed to your main web site (charges may be incurred for domain name hosting depending on which hosting plan is selected).

PART 3: PASSWORD FOR E-MAIL ADMIN/FTP ACCESS  Please create a Password below. Username: will be assigned by MediaBlend * Password: (Should be at least 5 letters minimum - numbers and letters are recommended)

PART 4: CUSTOMER/BILLING INFORMATION * First Name: * Last Name: Company Name: * Billing Contact: * Billing Address 1: Billing Address 2: * Billing City: * Billing State: * Billing Zip: Country: * Phone: Extension: FAX: * E-Mail Address: How did you hear about us?: Promotional Offer Code:

*Credit Card - Visa / MasterCard: (U.S. and International customers - a charge will appear on your statement from MediaBlend after the first business day of the billing month) 6 Month Term in Advance Annual in Advance (5% Discount) * Card Type Select Card Type Visa MasterCard * Card Number --- * Exp. Month MM 01 02 03 04 05 06 07 08 09 10 11 12 / * Exp. Year YYYY 2004 2005 2006 2007 2008 2009 2010 2011 * CVV Number * Name on Card Complete the following only if the address where the Credit Card Statement is sent to is different from the Billing Address listed in Part 4 above: CC Statement Street Address CC Statement Zip Code

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