Please note: UNDER NEW OWNERSHIP! We are in the process of doing a major overhaul on the website and system. NO New signups will be accept at this time. Thank you.

The information collected from this form will be used within your site therefore
     ALL questions must be answered except where noted as optional.
Do you have a Registered Domain Name?:

YES       NO

If Yes, please enter your Domain Name/URL here:
http://www.  . 
If No Click Here to register your Domain Name
OR
Click Here to transfer an existing Domain Name to our services.
Will you be bringing your own Graphics?:

YES       NO

Are you purchasing or have you purchased one of our Graphics Packages?:

YES    NO    Still Looking

What type of Website are you creating?:
Arts and Crafts ($20.00/month)
Small Business: not art/craft related ($20.00/month)
Store Front: non-selling ($10.00/month)
Personal Homepage: non-selling ($10.00/month)
What Layout do you plan on using for your Website Template?:
Arts and Crafts
        or
Small Business: 		A B C
View Samples
Store Front: A    
View Sample
Personal Homepage: A    
View Sample
First Name:
Last Name:
Business Name:
Email Address:

             (*must be current/valid)
Alternate Email (optional):
(for submissions and junk mail)
Street:
City:
State/Province:
Country:
Zip/Postal:
Phone:
(include area code ie: 613-744-1234)
Private?:  Public?: 
Fax:
Tax Rate:
(for your State/Prov)
%
Do you accept MasterCard?:

YES       NO

Do you accept VISA?:

YES       NO

Do you accept AmericanExpress?:

YES       NO

Do you accept Discover?:

YES       NO

Do you accept PayPal?:

YES       NO

Do you accept Money Orders?:

YES       NO

Do you accept Checks?:

YES       NO

Make Checks Payable to?:

Your Name
Business Name

Referred By:
     


Services provided by U-Maintain-IT!~ All Rights Reserved © 2003
Everything you need for the World Wide Web and More!