PRODUCTS/SERVICES	ADDITIONAL
Website: << Check this box to start! Create: Create New Website Use My Current Site Banners: Create Advertisers' Banners No Advertisements at site We will decide later	Flash Animation $10.00 per month  Shopping Cart $10.00 per month  Merchant Gateway $5.00 per month  Secure Server $20.00 per month
Total Monthly Subscription Amount: This amount is the total monthly subscription fee that must be paid on the first of each month.

Step 2 of 4:
PROVIDE UP TO 5 DOMAIN NAMES FOR REGISTRATION

If you already have a registered domain name that you want to use, you may enter it here.

This is based on "order of preference." We will first check for choice 1, then choice 2, then choice 3, etc., until we find the name that is available. No two businesses or individuals can have the same domain name on the Internet; and because domain names are being registered by other companies and individuals in an overwhelming number, your actual business name or preferred domain name might not be available.

Domain Choice 1:	*
Domain Choice 2:
Domain Choice 3:
Domain Choice 4:
Domain Choice 5:

Step 3 of 4:
PROVIDE UP TO 9 E-MAIL ADDRESSES (Username, Password, Notes)

After we register your preferred domain name, your username will be attached to the domain names to form your e-mail address, e.g., Username@DomainName.Com. Just as with your domain name, it is better to have an e-mail address that is short and easily understood.

Your password should be a word that you will be able to easily remember. It is also a good idea to write down and keep your passwords at a safe place in case you forget your password. You can use a combination of letters and word, but it should start with a letter and have no spaces within it. Although you can create a longer password, it is better to try to keep in within 8 digits.

You can use the "NOTES" space to give the e-mail addresses to which mail sent to each e-mail must be forwarded. For example, if you already have a YourName@yahoo.com e-mail address and you prefer to continue using it, you could still create a new e-mail address at your domain, for example, sales@MyDomain.com and have it forwarded to YourName@yahoo.com. All mail that your customers send to sales@MyDomain.com will automatically go to Yourname@yahoo.com

EMAIL Username		EMAIL Password	EMAIL NOTES
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Step 4 of 4:
PROVIDE CONTACT INFORMATION (Locations, MiSR, Billing)

PHYSICAL BUSINESS If you have more than one business location, you should only provide the physical location to your main branch or the branch for which this sign-up is being executed.
Business Name:	*
Business Phone:	*
Business Fax:
Business Type:
Business Address:
Business City:
Business State:
Business Zip:
Copy Address to:	MiSR   Billing
Main iNTELLESIS Subscriber Representative (MiSR) The individual responsible for and the only person who can change this account. Name and other particulars must be filled in. Address can be left out if same as Physical Business.
MiSR Full Name:	*
MiSR Phone/Cell:	*
MiSR Job Title:	*
MiSR E-mail:
MiSR Address:
MiSR City:
MiSR State:
MiSR Zip:
Back-up MiSR:	Enter the name, phone, address and related instructions about other individuals who are authorized by the MiSR to effect changes on this account.
BILLING INFORMATION You will be billed only after the website has been published.
Billing Method: [select one]	By E-mail (Electronic Invoice)  US Postal  Credit Card
Billing E-mail:
Billing Name:
	Don't fill out address if same as Physical Business address or MiSR address.
Billing Address:
Billing City:
Billing State:
Billing Zip:
Billing Phone:
Billing Fax:
COMMENTS: QUESTIONS: INSTRUCTIONS:
	Please thoroughly verify your information, at least once, before submitting it. An inaccurate submission may delay the setup of your website. Go PageTOP