This order form is to order Email/Starter hosting. 

The cost for this hosting is $59.40 ($4.95/month) for 1 year.
To receive this price you must pay for 1 year.

To pay for 3 or 6 months you must supply us with a credit card
on file for payment.
6 months - $35.70 - $5.95/month
3 months - $20.85 - $6.95/month  
 

Domain Name To Registered/Modified: _________________________

Are we registering this domain?  ____ Yes

Are we modifying this domain? ____ Yes

Organization Name: ___________________________________

Your Name: _________________________________

Address: ____________________________________________________

Phone:  ____________________ Email:  ________________________

----------------

If paying by credit card:

Credit Card#:  ____________________ Exp Date:  ________________

Cardholder Name:  _________________ Card Zip:  ________________

Paying for:
___ 12 months - $59.40 - $4.95/month
___  6 months - $35.70 - $5.95/month
___  3 months - $20.85 - $6.95/month

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 F.W. Hosting.