CJS Host - Web Site Hosting Order Form

Items with an * indicate required fields

*Your Name:

Company:

*Address:

*City:

*State:

*Zip Code:

*Phone Number:

*Email Address:

*Desired Domain Name:

*New Domain or Transfer:

If transfer, what is your current host:

Circle desired plan:

1
Presence
$5.00

2
Basic
$10.00

3
Dial Up
$16.95

4
Professional
$25.00

5
Business
$40.00

6
Corporate
$75.00

7
Enterprise
$100.00

Setup Cost:

1
$0.00

2
$20.00

3
$20.00

4
$25.00

5
$25.00

6
$35.00

7
$40.00

Total:

Please make checks payable to CJSHOST

By submitting this form you agree to all terms and conditions listed in Policies.
(www.cjshost.com/policies.htm)

Thank you for your order!!

*Signature:

*Date:

Please Print and mail completed form and payment to:
CJS HOST Sales
7310 Scotland Road
Akron, NY 14001-9683