Order by Fax or Mail

ORDER BY FAX OR MAIL

IMPORTANT INSTRUCTIONS

Please fill out this form by typing in the information. Then print and fax it or mail it to the mailing address specified at the bottom of this form. We will begin setting up your account upon receipt of this form. Once your account has been setup, you will receive information and instructions on how to provide us with the information we need to setup the service(s) that you have selected. Please note that if you are paying by credit card, your credit card will not be charged until the service(s) that you have selected have been completed.

If you have any questions or comments please call us at

(704) 672-1600

YOUR ORDER NUMBER IS

Hit Counter

BILLING INFORMATION (If paying by credit card this address must be your credit card billing address)
Method of Payment:
Credit Card Type:
Credit Card Number:
Expiration Date:	/
E-Mail Address:
Billing Name:
Street Address:

City:
State:
Zip Code:
Phone Number:
Fax Number:
Account Representative:

COMPANY INFORMATION (If different from above)
Company Name:
E-Mail Address:
Mailing Address:
BLANK
City:
State:
Zip Code:
Phone number:
Fax number:
PLEASE SELECT THE SERVICE YOU WOULD LIKE TO ORDER FROM THE LIST BELOW You may select multiple services

MEMBERSHIP SERVICES
Description	Monthly	Semi-Yearly 10% Discount	Yearly 20% Discount
Subscriber Membership	$ 9.95	$ 54.00	$ 96.00
Hosting Membership	$ 19.95	$ 108.00	$ 187.00
Access Membership	$ 32.95	$ 178.00	$ 316.00
WEB HOSTING SERVICES ($ 20.00 setup fee applies to these services)
Description	Monthly	Semi-Yearly 10% Discount	Yearly 20% Discount
Personal Web Hosting	$ 19.95	$ 108.00	$ 192.00
Business Web Hosting	$ 24.95	$ 135.00	$ 239.00
e-Commerce Web Hosting	$ 79.95	$ 432.00	$ 768.00
REGISTRATION SERVICES
Description	One Time	Quarterly (Over One Year) 10% Discount	Quarterly (Over Two Years) 20% Discount
Search Engine Registration	$ 69.00	$ 248.00	$ 442.00
ADVERTISING SERVICES
Description	Quarterly Contract	Six Month Contract	Yearly Contract
Category Page Top Banner	$ 135.00	$ 243.00	$ 432.00
Category Page Medium Side Banner	$ 105.00	$ 189.00	$ 336.00
Category Page Small Side Banner	$ 75.00	$ 135.00	$ 240.00
INTERNET ACCESS SERVICES
Description	Monthly Rate (Includes Setup Fees)
56K V90 Dial Up (Unlimited) Two e-mail addresses	$ 21.95
56K V90 Dedicated Analog Five e-mail addresses	$ 100.00
64K ISDN Dial Up (Unlimited) Two e-mail addresses	$ 75.00
64K ISDN Dedicated Five e-mail addresses	$ 125.00
128K ISDN Dial Up Ten e-mail addresses	$ 119.00
128K ISDN Dedicated Twenty e-mail addresses	$ 200.00

PRINT THIS FORM BY USING YOUR BROWSER'S PRINT BUTTON

FAX THIS FORM TO
(704) 672-1629

OR MAIL IT TO
Carolinas Network Company
Order Processing Center
P.O. Box 1491
Cornelius, NC 28031-1491

AFTER YOU PRINT THE ORDER FORM CLICK
ON THE SERVICE YOU WOULD LIKE TO SETUP BELOW

Setup Membership Services

Setup Internet Access