Secure Service Request Order Form

Please take a moment to complete this service order form.
On receipt of your payment your web site will be
configured and available within 24 hours.

Your Name:
E-mail. Address:
Phone: i.e. 604-555-1234


If you require assistance completing this order form, please
contact us support@agapedata.com and an accounts representative
will contact you promptly.

PRIVACY STATEMENT: The information entered here will
be used only by Agape Data Solutions / Flightweb and will not
be released to 3rd parties under any circumstances.


1. Select the size and type of account you require

Item Description   Price
New Account Setup Required for new accounts $ 0.00
       
Personal Package 500 MB storage, virtual server, 5 POP acct. $ 9.00
Economy Package 1 GB storage, virtual server, 10 POP acct. $ 14.00
Standard Package 2 GB storage, virtual server, 20 POP acct. $ 26.00
Business Package 5 GB storage, virtual server, 30 POP accts. $ 39.00
Enterprise Package 10 GB storage, virtual server, 50 POP accts. $ 49.00
Scheduling System Online scheduling system only (no hosting) $ 25.00

 

  2. Billing Contact Information

Last Name:
First Name:
Title:
Company:
Address:
City:
Prov/State:
Country:

Postal/Zip Code:

Phone: i.e. 604-555-1234
Fax: i.e. 604-555-1234
E-mail:

 

3. Identify who will be the registered owner of the domain name

Same as billing contact:

Last Name:
First Name:
Title:
Company:
Address:
City:
Prov/State:
Country:

Postal/Zip Code:

Phone: i.e. 604-555-1234
Fax: i.e. 604-555-1234
E-mail:

 

 4. Details about your site and domain

Short Description of your
Business or Service:
Domain Name: www.
Domain Status: New domain name $15 /yr or free*
Transfer existing domain name
* Domain name registration is free for annually renewed Standard, Business or Enterprise Accounts
Will you be using Frontpage on your account? Yes No
Notes:
Where did you hear about us? Google
Yahoo
Other Search Engine
Web Hosting Related Site
Word Of Mouth
Other

5. Select any additional services you require

Item Details  
Price
POP E-mail. Accounts
list names
List the email addresses you would like set up.

Extended Logging

  $
0.00
Domain Alias domain name $
19.00 setup
Additional User Accts. list names $
0.00

 

6. Payment
Renewal Cycle: Monthly (requires credit card)
Quarterly (credit card or invoice)
Annual (domain name free)
Payment Method: Credit Card Invoice
Type of Card:
Card Number (please double check):
CVV Number on card
Expiration Date: month year
Name on Card  
Cardholder Address  
Cardholder Zip/Postal Code  

Manual Billing
By default your hosting fees will automatically be deducted from your credit card each billing cycle. If you would prefer to be invoiced and submit payment yourself each billing period, please select Manual Billing.

Automatic Payment

Manual Billing


7. Signature


Please type your full name in the box below. By doing so and submitting this form to Agape Data Solutions you are agreeing to the terms, conditions and acceptable use policy previously set forth by Agape Data Solutions.

Before submitting your order please double-check it for accuracy. Make sure you are registering the correct domain name you want. The domain name registration fee is non-refundable. Please also make sure you filled out all the required fields.

Enter what you see