GlobalFront Virtual Hosting Order Form

Services Ordered
*Account Type and Prices:** GlobalFront Web Services is registered in the states of Minnesota and Iowa. If your billing address is in Iowa or Minnesota,* then you would need to add, or authorize us to add, Minnesota Sales Tax (6.50 percent), Minnesota Local Sales/Use Taxes (if applicable), or Iowa Use Tax (5.00 percent) to the net total for all orders. (GlobalFront's Minnesota Sales/Use Tax Permit # is 8022142) (GlobalFront's Iowa Use Tax Permit # is 2-00-151660)
Please use our domain lookup utility to verify availability if you are ordering a new domain, or to verify registrant and contact information if you are moving an existing domain. Please enter your domain name (e.g., mybusiness.com) in the following field.
Domain Name (First Choice):	Domain Name (Second Choice):
Domain Registry Information: Domain registry or InterNIC fee applies to all new domain registration. If you are asking for a new domain name to be registered for you, then you would need to add the appropriate domain registry fee along with your payment. Domain registry fee is non-refundable, even if you cancel the services before the end of the term. We also host foreign domain names. If you would like to register a foreign domain name, then please contact your respective NIC agency or ask us, and we will be able to help you.
Desired Password (8 case-sensitive letters and numbers):
Website Development and Design Services (Optional):
Estimated price for custom design (optional):
Content Type (required):	FrontPage Server Extensions Check this box only if you are using Microsoft FrontPage for site design
Referrer or Ad ID from referrer or advertisement. Required to qualify for any appropriate discount or additional service:
Invoice Type:
Payment Option:
Information about You and Your Organization/Business
Preferred Title (Optional):	Name (First M. Last):
Email Address:	Business/Organization Name:
Phone Number:	FAX Number (if applicable):
Present URL (if applicable):	How did you find about us?
Please describe your organization (or yourself) and intended use of this account:	Please specify here if you have any special instruction regarding your order:
Street Address (1):	Street Address (2):
City:	State:
Zip/Postal Code:	Country:
Your Authorization
By submitting this form, I acknowledge that I have read and understood the service description and payment plan(s) for the requested service(s), and that I agree to make payments on time for the requested services. By selecting "I Agree" in the box below and clicking the submit button, I further acknowledge that I have read, understood, and agree to comply with GlobalFront policies as posted in GlobalFront website at http://www.globalfront.com/services/policies/index.html . If you agree to the above, please select "I agree" Here: After placing the order, you would need to pay for the order amount before we can process the order. Thanks.