Please sign and Fax form to: 847-480-9715
And be sure to fill out our promotion form.
Check here for domain name availability.
I confirm that I have read and agree to all terms and conditions set forth
in this document and further agree to purchase one of the services
Authorized Signature: ___________________________ Date: ___________
Company Name: ____________________________________
Contact: _________________________________________ Phone: _______________
City: _________________________ State:_________ Zip: ___________
Phone:__________________ FAX: _______________________
Domain Name__________________________. Please give two choices for a
Domain Name, (consists of the rightmost word after the "@" symbol in the
email address ending in .com for commercial or .org for organization. This
name may include a hyphen. Numbers and symbols may not be used.) All
attempts will be made to get your first choice.
You can check for Domain Name availability using this form.
1) _________________________ . com
2) _________________________ . com
I am enclosing a check or money order in the amount of $ ____________*
payable to MicroWeb Technology, Inc.
Send Completed Form and Funds Made Payable To:
MicroWeb Technology, Inc.
PO Box 2384
Northbrook, IL 60065-2384
Date: _________ by _____
* See MicroWeb Technology, Inc. Rates and Services Sheet for details.
©Copyright MTI, Inc., 1996