You may order any of our services by snail mail (US Mail).  Simply print and fill out the following information, and mail to the address below.  All Checks or money orders should be in US Funds.  All Checks should be drawn on a US Bank.

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Date:____________ Time:____________ Zone:__________

First Name:______________

Last Name:________________

Email Address:________________

Business Name:_______________________

Please note that Internic will bill you directly for Domain name registration.
The current registration rate is $50.00/year first two years payable in advance.
Their Normal terms are 30 days from activation.

Organization description or special notes

____________________________

____________________________

____________________________

Address Information:

Line 1:____________________Line 2:____________________

City:____________________State:____________________

Zip/Postal Code:_______________Country:_______________

Phone:_______________ Fax:_______________

Account ?

SOHO  Business 1 Business 2

Corporate 1 Corporate 2 Corporate 3

Options requested:

Microsoft Frontpage (most cgi scripts supported)

Real Video/Audio $25.00/mo Real Audio $12.00/mo

Java Chat $12.00

 

Domain Information:

New Domain

Modified/Transferred Domain

Domain Name ____________________ (if existing)

Requested Domain Name ____________________

Second Choice ____________________

Requested Domain Password ____________________

Payment Method:

Credit Card

Check online/fax

Snail Mail (credit card/check or money order US funds)

NOTE:  All check/money order payments require a first and last
month's deposit.  Please submit three month's charges, plus setup
fees.  Don't forget to add amounts for options.   Contact us if further
arrangements are necessary.
Credit card Info:
Name on Card: ____________________
Card Number:____________________

Expiration:_______________

Card Type: Visa MasterCard American Express Discover
Infopage Services
5261 Highland #395
Baton Rouge, La. 70808
504-757-9341
504-768-7295(fax)