Bronson-Tate Consulting

Standard Account

Package #3
Virtual Domain Hosting
Request Form

Fill out the form below, to sign up for our Standard Package #3, Domain hosting services
After you are done select "Send Info".

All fields must be filled in.

Your Name:

Address:

City: State:      Zip Code:



E-Mail Address:

Day Time Phone Number:
(Don't forget the Area code)

Briefly explain your web site:

Enter "None" on the next three lines, if this is a personal web site.
Company Name:

E-Mail Address:
(Enter "None" if you don't have one.)

Day Time Phone Number:
(Don't forget the Area code)

Your Domain URL:
(Example, www.your-name.com)

Have you already registered this name.
     YES       NO
If the above is "NO",
Do you want us to register it for you.
     YES       NO
Please place additional instructions in the box below.
(The box will expand as necessary)

I have read and understand the "Terms and Conditions"
set forth by Bronson-tate.net.
I agree to abide by them.
Yes, I Agree
No, I Disagree



Price for Package 3 is as follows:
   $19.95 per month for disk space and access.
+ $60.00, one time set up fee.
   $79.95 Total, due upon completion of setup.

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Contact web master at:
Bronson-Tate Consulting

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