Logic 1 Design and Services -- Services

Web Hosting Account Order Form
Domain Name Information
*Domain Name
*Registration	New Domain 1yr. $19 New Domain 2yrs. $35 New Domain 5yrs. $75 New Domain 10yrs. $150 Transfer Domain $15 (includes 1 additional year) Do not register or transfer, just send me the name server information
Contact Request - Check this box if you have special instructions on how you would like your domain processed, and we will contact you before taking any action.
Contact me first
Additional Services
Additional 100MByte blocks of Disk Space at $20/yr	- Enter number of additional blocks requested
Additional Email accounts (in blocks of 10) at $20/yr	- Enter number of additional blocks requested
Additional Domain names pointing to this web site, at $20/yr for each one
Yes, Add these Domains
Enter additional Domain names (ex: yourdomain.net yourdomain.org)
Billing Contact
*Name
Organization
*Street Address
*City
*State, ZIP/Postal Code	State: ZIP:
Country
*Phone Number
Fax Number
*E-Mail Address (ex. you@youremail.com)
Additional Account Information
Please tell us how you found us
Please enter the name of the referring party
*Detailed Description (You may also use this area to supply any additional notes regarding your website)
Purpose of Web-Site

Payment Information

You will be contacted by e-mail or phone, to confirm this account information. You will be billed after you have confirmed this order. Payments can be made on-line with a Credit Card, or by check or money order Paid to:
Logic 1 Design and Services, LLC
4346 W. Acoma Dr.
Glendale, AZ. 85306-4504

NOTE: Our current policy expressly forbids any Adult Related Sites, and spamming of any kind.

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