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Domain Hosting Order Form
( continued )

Please complete the next step by verifying the information given on this page.

If you have any questions, please call us at
888-546-5668 or 310-544-9655
sales\@creativelinkpartners.com

Verify Your Order Information

The information you entered on Page 1 of our order form has been entered into our database. Please verify that all of the following information is correct. If anything is incorrect, do NOT use your browser's back button to attempt to correct your info on the previous page. Instead, use the 'Modify Your Order' button to access the information already in our database. Then submit your corrected information to return to this page.

Domain name:	$fields{'domain'}
Plan Type:	$fields{'plan'}
Contract Length:	$fields{'term'}
Domain Registration:	$fields{'order_type'}
Register Domain Name:	$fields{'internic'}
Account Type:	$fields{'type'}
Special Instructions:	$fields{'special'}

Name:	$fields{'fname'} $fields{'lname'}
Company Name:	$fields{'company'}
Address:	$fields{'add1'} $fields{'add2'}
City, State Zip:	$fields{'city'}, $fields{'state'} $fields{'zip'}
Country:	$fields{'country'}
Phone:	$fields{'area_v'} $fields{'phone_v'}
Fax:	$fields{'area_f'} $fields{'phone_f'}
E-mail:	$fields{'submit_by'}

Billing Information

Full Name as it appears on your credit card

Please bill this to my:

Address: Must be same billing address as your credit card. Including ZIP CODE

Visa, Mastercard, Discover or AMEX
I will be mailing a check.

Credit Card Number

Expiration Date

I authorize the charges to my credit card.