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International Web Hosting
Online Secure Order Form
      FIELDS MARKED WITH * ARE REQUIRED!
   Personal Info :
 Company Name:
 First, Last Names:*
 Address:*
 City:*
 State/Province:*
 Country:*
 Zip/Postal Code:*
   Contact Info :
 Home/Business Phone * Area:*
 Name of your Internet Service Provider
 eg. www.sprint.com, www.att.net etc.
*
 E-Mail Address you have with your ISP:*
 Alternative E-mail Address:
 eg. hotmail.com, yahoo.com etc.
   Domain Info :
 Domain Name:*
To see if it's available or to Register your Domain Name go to www.amrayweb.com Domain not registered yet
Registered by AMRAY
Want to move to AMRAY
Want to Renew
Hosted by AMRAY
   Hosting Info : *
 This is a: New Account
Renewal
   Please select a Hosting Plan:* - $$$USA$$$
$6/month - $72/year 100mb of space Personal Hosting
$10/month - $120/year 300mb of space Business Hosting
$15/month - $180/year 300mb of space e Commerce
   Please select a Payment Method:*
To pay by:     or     Please use this form below
 Name on Card:
 Cardholder Phone Number: Area:
 Card Number:  -   -   - 
 Issuing Bank
 Zip Code of Billing Address
Expires: Month: Year:
Cashier Cheque: To: AMRAY NETWORK CORPORATION
P.O. Box 343
Winnipeg, MB
R3C 2H6 Canada
Money Order:
Other Credit Cards:
If you prefer to pay by Cashier Cheque or Money Order
then just Submit this Form.

If you prefer to pay by AmEx or Discover Card, you will be provided
with link to PAYPAL after you complete this Form

PAYPAL
 Connection used :  
How did you find us :  

By checking this box and by clicking Submit, you are declaring that you has read, agreed with and accept the Terms and Conditions of the Service Agreement and that you are now ready to be billed by AMRAY for selected services.

Information you provided in this Form must be accurate and verifiable