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PAYMENT ACCEPTED


1
 Your Full Name: (required)
2
 E-mail Address (required)
It is VERY IMPORTANT that you provide a valid, working e-mail address so we can deliver your account details to you.
3
 Alternate E-mail Address
If you have an AOL or CompuServe account, this is strongly advised.
4

The DOMAIN NAME(s) we are hosting for you:
(If you are an existing customer)
5 I am ...
6
 Questions or comments:
(Please be as specific as possible so we can provide a thorough response.)
7
 Your privacy is protected.
By checking this box, you understand that we will not share, rent or sell your name, email or other information with any other party. Information submitted will be used by Teknon Media only. You agree to receive follow-up email from Teknon Media in order to accomodate your request for information.
 
 
 

 


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