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Web Hosting Order Form

Please fill out the following order form completely.

Fields marked with a * are required.

Customer Information
First Name*:
Last Name*:
Company Name:
Address*:
City*:
State/Province*:
ZIP/Postal Code*:
Country*:
Telephone*:
Fax:
Existing e-mail address*:

 

Account Information
Account Type*:

WC Basic
WC Business
WC Pro
WC E-Commerce

Payment Term*: Monthly
Quarterly
Yearly

 

Domain Information
What domain name do you wish to use with this account?*:
Has this domain name been registered? Not Registered
Registered
If your domain is "Not Registered"

Would you like us to register it for $25 per year?
Or will you handle the domain registration?

We will register your domain name and the fee for one year of registration is only $25. This registration fee will be added to the total amount due and is non-refundable.

Register ($25/yr.) for
Please pick a password for your domain registration management (6 - 10 letters or numbers):

I'll take care of it myself
If your domain is "Registered"

Would you like us to initiate the nameserver modifications for you for free?

Initiate the modifications for me please!
I'll take care of the modifications myself.
My domain is already registered with Internet Magic.

 

Payment Information
You may pay for your hosting account by choosing one of 3 methods:

1. Online - Finish filling out this form and send it through our secure server by clicking on the submit buttons.

2. Fax - Finish filling out this form, click the "Verify Order" button and then print the next screen and fax it to us at :

               1-707-584-2997

3. Snail Mail - Finish filling out this form, click the "Verify Order" button and then print the next screen and mail it to us at the address below. If you wish to pay by check or money order, please include payment with the order.

 

Internet Magic

5111 York Court
Cape Coral, FL 33904

Payment Method*:

Credit Card (Please fill out the Credit Card Information section below)

I will mail a check or money order. ( Note: Your order will not be processed until your check clears our bank (approx. 10 days) or until we receive the money order. Returned checks will be charged a $25 fee. )

I am submitting an online check. Please fill out the Online Check Information section below. Note: Your order will not be processed until your check clears our bank (approx. 10 days) or until we receive the money order. Returned checks will be charged a $25 fee.

IMPORTANT: All accounts paid by check, whether online or sent in, must be paid on a yearly basis.

Credit Card Information
Card Type:
Name on Credit Card:
Credit card number:
Expiration Date:
Billing Address of
Credit Card (if different
from above address)

IMPORTANT: For subsequent recurring payments, this card will automatically be charged each month, quarter, or year. You can, at any point, change your billing info should you need to.
The vendor shown on your credit card statement will be Internet Magic and the charge will be for the total shown on the next screen.
Online Check Information

Check

Name On Check:
Transit Routing Number:
Account Number:
Check number:

Please note: your order will not be processed until this check clears our bank (approx. 10 days)
IMPORTANT: For subsequent recurring payments, this account will automatically be charged each year. You can, at any point, change your billing info should you need to.

Your check will be made out to Internet Magic for the total that will be displayed on the next screen

There is a $25 fee for returned checks.

 

General Information
Please tell us how you heard about us:
Any comments or questions?
 
By submitting this order you agree to comply with the Terms and Conditions Agreement.
 



webclickhosting.com
a service of Internet Magic
5111 York Court
Cape Coral, FL 33904
1-877-201-8859 toll-free
707-869-3389 phone
Contact Us