EliteHost.net: Web Hosting Order Form

Web Hosting (cPanel & WHM) Order Form

cPanel Plan Pricing	Basic	Premium	Professional	Advanced
2 Year Price	$4.00/mo	$7.00/mo	$11.00/mo	$13.00/mo
1 Year Price	$6.00/mo	$9.00/mo	$13.00/mo	$15.00/mo
6 Month Price	$8.00/mo	$12.00/mo	$15.00/mo	$18.00/mo
1 Month Price	$10.00/mo	$14.00/mo	$17.00/mo	$20.00/mo
Setup Fee	$0	$0	$0	$0

WHM Reseller Plan Pricing	Basic	Premium	Professional	Advanced
2 Year Price	$11.00/mo	$18.00/mo	$30.00/mo	$45.00/mo
1 Year Price	12.00/mo	$20.00/mo	$35.00/mo	$50.00/mo
6 Month Price	$13.00/mo	$22.00/mo	$37.00/mo	$55.00/mo
1 Month Price	$15.00/mo	$25.00/mo	$40.00/mo	$60.00/mo
Setup Fee	$0	$0	$0	$0

Section 1: Customer Contact Information

E-mail Address:
Full Name:
Current Customer?:	If Yes, domain(s) hosted:

Referred by:

Section 2: Hosting Plan Details

Type of Account:
Hosting Plan:
Dedicated IP:
Priority Level Support:
Adult Content:	(will you be hosting adult content on this account?)
Domain Name:	(this is the main domain name for your account)
Payment Terms	(See chart above. Save $$ by pre-paying for your plan in advance)

Section 3: Billing Details

Credit Card Type:

Card Number:

Expiration Date: (MM/YYYY)

CVV2/CID

Street Address

City

State

Zip Code

Full Name on Card

Section 4: Submit Order

By submitting this order form, you hereby agree and accept to EliteHost.net's Acceptable Use Policy located at http://www.elitehost.net/aup.php