UnitBuilder - Account Sign Up Form

 

Web Site Order Form - Please complete the form below
Name
 Contact
Address
 		Phone
City
Fax
State
 		Email
Zipcode
 		 

Please select :

I want my own Domain name! Set up site for $19.95 per month (plus a one-time $79.00 set-up fee)!

 

  

Current Site Information

If you have a web site, what is the URL?

Would you like your current site moved? (this is optional)
Would you like to have your web site copied and moved? The cost for this is
$159.00 and includes the following:
- Your new site set up
- All menu items and pages recreated similar to your current site
- Up to 25 .pdf, .doc files moved to your new site
- Up to 15 pages copied from your old site to your new site

YES! Please copy and move my site for me! I realize that there is an
additional charge of $159.00 for this service.

 

  

This section applies only if you are requesting your own domain name

Requested Domain Name - 1st Choice

 
Please check only one - .com .net .org .info .biz .us  


Requested Domain Name - 2nd Choice

 
Please check only one - .com .net .org .info .biz .us  
   


Please select the following:
User Name 		 
Password  



Payment Information (Visa and Mastercard Only)

Name on Card
Card Number
- - -

Expiration

I agree to have my credit card charged each month
in the amount of $19.95 for my monthly web site fee.
I also understand that there is a $79.00 set-up fee
that covers the registration of my domain name
and set up of my site.

 

  

Yes, I have read and understand Client Agreement
(click here to view)

Additional Message or Comments: