Please provide the following contact information:

First name

Last name

Middle initial

Title

Organization

Street address

Address 2

City

State/Province

Zip/Postal code

Country

Work Phone

FAX

E-mail

URL

I would like to:

 Request further information

Place an order for service

 If you are placing an order for hosting services, please fill in the following information:

 I would like to pay via:
Check or Money order (made payable to Netfeed Internet Services): 
Note: Payment by check will delay account activation until your check clears the bank.

 Mail check or money order payments to:

 Netfeed Internet Services
1608 Sunrise Ave. Suite 6
Modesto, CA. 95350

 Visa or Mastercard (Account activation within 24 hours):

 Visa: 

MasterCard: 

Account Number: Exp Date: 

Bill me for: One Month Basic Self-Serve (no Domain Name)One Month Virtual Domain Self-Serve4 Month Virtual with 5% discount6 Month Virtual with 10% discount12 Month Virtual with 15% discount4 Month Self-Service Basic with 5% discount6 Month Self-Service Basic with 10% discount12 month Self Service Basic with 15% discount

Domain name 

If interested in a Virtual Domain make sure to click here to check to see if the Domain Name is available

 I understand I will be billed for the following fees:

 Setup fee (one time only): Self Service, non-virtual: $50.00Self Service Virtual: $200.00 (includes InterNIC fees)

Monthly charges: Self Service Basic: $29.95Self Service Basic 4 month: $113.81Self Service Basic 6 month: $161.73Self Service Basic 12 Months: $305.49Virtual Domain 1 month: $49.95Virtual Domain 4 months: $189.81Virtual Domain 6 months: $269.73Virtual Domain 12 months: $509.49

I understand that by submitting this request I authorize these charges to be made.

 Choose a username: This will be the directory portion of your URL for a non-virtual site and will serve as your user ID for FTP access for both non-virtual and virtual sites. This must be between 4 and 8 characters in length (all lower case).

 Choose a Password: 8 to 16 characters combining upper and lower case letters and numbers. Cannot be any form of your User ID
Re-Enter Password for Confirmation: 

  Detailed Comments
 
 

Choose the product you are interested in:

Web Design ServiceVirtual Domain HostingNon-Virtual Self ServiceFull Maintenance Web Page(s)

Choose how you would like us to respond to your request:

Email 
Postal Mail 
Phone

 Please type any details you feel appropriate concerning your request.

 

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