This order form is to order basic hosting. The cost is $9.95
per month and we bill in 3 month intervals.  
 

Domain Name To Registered/Modified: _________________________

Are we registering this domain?  ____ Yes

Are we modifying this domain? ____ Yes

Organization Name: ___________________________________

Your Name: _________________________________

Address: ____________________________________________________

Phone:  ____________________ Email:  ________________________

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If paying by credit card:

Credit Card#:  ____________________ Exp Date:  ________________

Cardholder Name:  _________________ Card Zip:  ________________

Your credit card will be billed for $29.85 if you already have
a domain. Your billing will be for $44.85 if you are requesting
a domain registration ($29.85/hosting + $15.00/registration).

If you authorize us to use your credit card for automatic billing
you will not be billed every 3 months by email. Your account will
automatically be billed and you will receive a 10% discount. You
will also receive a 10% discount for payment 1 year in advance.

Do you authorize us to use your credit card for automatic payments?
_____ Yes           _____ No

Complete credit card info above or send a check to:

MinnesotaShopper.com
P.O. Box 703
Grand Rapids, MN  55744


All charges on your credit card will come from MinnesotaShopper.com.