Contact
Information:
All
information is kept confidential. We will
always attempt to contact you via email
before using the information provided. |
| Name
(M) |
|
Company
Name
(if applicable) |
|
| Address
(M) |
|
| City
(M) |
|
| State/Prov.
(M) |
|
| Postal
Code (M) |
|
| Country
(M) |
|
| Current
E-Mail (M) |
|
| Day
Telephone (M) |
ext.
|
| Evening
Telephone |
ext.
|
| Setup
Information: |
| Please
select package (M) |
|
| Please
specify term (M) |
|
| Domain
Name |
www.
|
| Would
you like us to register your domain name
with Internic? (M) |
Yes! Register a new domain
Yes! Transfer my existing domain
No! I'll do it myself
Regular
US$70.00 Internic fees apply to all
new domain registrations. Domain transfers
are not subject to any additional charges.
No! I don't want one
|
|
If
you are using a domain name, DO NOT
enter a username below. The domain name
will be your username.
(ie: your domain is "www.sysology.net",
your username is "sysology")
The
absense of a domain name will result in
a subdirectory account, which will appear
as "www.sysology.net/username".
|
| Username
requested (M enter only
if not using domain name) |
|
| Password
(M) |
|
| For
FTP packages only: |
| YES!
I want Anonymous FTP |
Enable |
| Billing
Information:
(All amounts shown are in CDN dollars. Foreign
payments are subject to the daily exchange
rate as set by the bank on the day of processing.)
|
|
Payment
type (M)
For
Canadian residents only: 7% GST is included
in the Total.
|
If
paying by cheque, your account will be
activated when cheque clears.
|
|
If paying by credit card, please enter
the appropriate information below:
|
|
Please
Make Cheque or Money Order Payable
To:
|
 |
|
Sysology
Inc.
|
|
224
Brunswick Ave.
Toronto, Ont., Canada
M5S 2M5 |
|
|
|
.
. . for the amount displayed in
the "Total" box above.
|
|
By
submitting this information, you are stating
that you have read our privacy
statement and that you agree with
our terms and
conditions of use.
|
