Please fill up the form below or download the pdf format.
 
1.  Administrative Information

Full Name

Company

Address

City/Town

Country

Zip/Postal Code

Email

Telephone

Hand Phone

Fax
   
2.  Select Type of Support Services
   

Website Maintenance
   
  Weekly graphic and text updates for
3 full mos.
 6 full mos.
 12 full mos.
 
  URL: 
   
Company Description/Type:
 
   
Website Promotions
  This information will be displayed on/or to Search Engines:

Site URL (s) to be listed in Search Engines:
 
 
 

Keyword 1

Keyword 2

Keyword 3

Keyword 4

Keyword 5

Keyword 6

Website title

Description

 

 (up to 250 characters only)
 

Choose Appropriate Category

 

  
Domain Name Registrations
 
 
NIC handle, if any:
   
** Please enter a valid email from your domain or your ISP...
Free or vanity emails are not allowed
   
Specify the domain name you want us to register for you below.  Provide at least 2 choices in case your first choice is reserved:

Domain Name

 .

Alternative 1

 .

Alternative 2

 .
   
Register my Domain Name for
(Php 1540/yr, VATt inclusive)
   
3.  Where did you hear about us?

Internet
Broadcast
Referral
Print
Sales Representative
Others 
   
4.  Payment Information

Please choose your preferred form of payment.

Cash
Check
Bank Deposit or Wire Transfer
  (please call us for bank details)
 
5.  Agreement

I confirm that the above information is true and correct.

Before submitting this form, please make sure that all required fields are complete.  By pressing the Submit Button, you are placing an order and agree to pay for the services ordered based on the current pricing plans.  To avoid submitting multiple orders, please press the Submit Button only once.

We will process your account once payment has been received. To expedite your order, fax us your validated check or deposit slip with your account name and your account will be activated within a day.