Wonderland Design Hosting Order Form

As you fill out this form, please know that no one
will have access to your credit card information.

For Credit Card orders, fill out this form.
Or call us at 530-926-0700 to place your order.
Call or e-mail us for any questions or for further information.

• SELECT A HOSTING PLAN • • SELECT A BILLING TERM •
 DORMOUSE 15 mgs $5.00 p/mo. 6 mo. required
 ALICE 50 mgs $12.50 p/mo.
 WHITE RABBIT 100 mgs $17.50 p/mo.
 TEA PARTY 250 mgs $21.50 p/mo.
 QUEEN of HEARTS 400 mgs $24.50 p/mo.
 WONDERLAND 600 mgs $34.50 p/mo.		  Monthly ($25.00 set-up fee)
 Quarterly (No set-up fee)
 Semi-Annually (No set-up fee)
 Annually (No set-up fee)
 Monthly is selected if you do not choose.

Do you need a web site designed for you?  YES    NO 

Is this a new Domain Name that needs to be registered?  YES    NO 

Domain Name
Pointer Domain(s)
 
 Select your User Name -- (Max. 8 digits, letters only)  
Name
 First
 Last
Address
City
State/Prov  
Zip/Postal
Country  
Phone
Fax (Optional)  
E-mail Address
Type of Payment
 Name on Credit Card
Credit Card #
   CVV2 
What is CVV2? Click for Information		 Exp Date: Mo    Year  
Optional
 Coupon Code   How did you heard about us?  
Special Instructions
 
Thank You for Your Order!

Your credit card statement will show a charge from "Orders @ StGermainCo.com" or Saint Germain Inc. which is our parent company."

This Form May Not Work With All Browsers

YOU ARE IMPORTANT TO US!

If You Have ANY Type of Problem Sending This Form
Please e-mail us or Call at 530-926-0700.

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