Order Form

If you are mailing your order, the address information is at the bottom of this page.
Please E-Mail sales@adultmarketing.net if you have any questions.

Privacy Statement - We never list you, nor any of our other customers, anywhere. Your private information is never sold and remains private.

*Required.

*Your Full Name:
Company Name:
*Billing Address:
 
*City, State, Zip:
*Country:
*Telephone # (day):
*Telephone # (night):
Fax Number:
*E-Mail Address:
Your current e-mail
address with your ISP
*Alternate E-Mail:
Such as a Hotmail
Address

Transfer existing domain  I'll register my new domain

If you have a new domain, you will need to register it, we recommend Register.com. If you're transferring from another host, we will submit the modification request for you.

*Domain Name:  www.

(Please specify domain ending)
*Choose User Name:
(Example, John Doe can use 'jdoe')
*Choose Password:
*Choose Plan:
*Contract Length:
Comments:

 All prices are in U.S. funds.

Please provide your payment information below:

*Credit Card Type:
*Credit Card Number:
*Expiration Date:
*Full Name on Card:
*Billing Address of Card:
*City, State, Zip:
*Billing Phone Number:

I authorize the billing to my credit card and agree with the terms of service outlined at: http://www.adultmarketing.net/agreement.html. I understand that additional bandwidth is $10/month per additional GB of monthly traffic, traffic is not pro-rated, and that I will automatically be billed for additional bandwidth if my traffic exceeds my chosen package above. I understand that accounts automatically renew after chosen contract period I will be billed automatically for the next term. I understand GlobalHosting, Inc. will be the company name which appears on my credit card statement.

 

 

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Signature                                                                                                    Date

To Complete your order please print this form and fax it to:

1.520.244.2169
1.800.886.7086 (Toll-Free)

If mailing payment / order, please make payment to:

GlobalHosting, Inc.
214 Second Avenue North, Suite 402
Nashville, TN 37201

Also Click the submit button: