First name
Last name
Middle initial
Title
Organization
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
Home Phone
FAX
Current E-mail
Current URL

CyberTec Web Hosting Services Change Request
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	Plan #1: 5 MB "Do It Yourself" - $15.00/3 Months
	Plan #2:  10 MB "Do It Yourself" 1 Email - $30.00/3 Months
	Plan #3:  10 MB "Do It Yourself" 5 Email - $45.00/3 Months
	Plan #4:  10 MB "Domain Forward-Do It Yourself" 10 Email -  $75.00/3 Months
	Plan #5:  25 MB "Domain Premium-Do It Yourself" Unlimited Email -  $105.00/3 Months + $30.00 Set Up
	Plan #6:  10 MB "Support" 10 Email - $144.00/3 Months
	Plan #7:  10 MB "Domain Forward - Support" 10 Email -  $174.00/3 Months
	Plan #8:  25 MB "Domain Premium-Support" Unlimited Email -  $204.00/3 Months + $30.00 Set Up
	Plan #9 "Custom Plan"  Let Us Know What You Need ! Please Provide Special Ordering Information Or Instructions Below.

Microsoft FrontPage Server Extensions Change Request
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	I will be using Microsoft FrontPage to publish my web site.  Please install FrontPage server extensions in my directory.
	I will be using Ftp to publish my web site.  I do not need FrontPage server extensions installed in my directory.

CyberTec E-mail Services Added Request
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Number E-mail Accounts

1 to 10 E-mail Accounts Included in Hosting Plans #2 - #8 - Free Unlimited pop/smtp E-mail Accounts - $9.00/3months/E-mail Please Specify E-mails usernames, Aliases, and Forwards Example: Email Account Name(Enter) (Less than 10 characters / Small letters / No spaces) Password Requested (Enter) (Less than 10 characters / Small letters / No spaces) Email Aliases separated by commas(Enter) (Less than 10 characters / Small letters / No spaces) Email Forwarding Address(Enter) (Current email that you want all email forwarded to) (Less than 10 characters / Small letters / No spaces) Blank Line (Enter) If you have trouble filling out this form as presented, please write down what you would like in plain English,  and we will make it so.

CyberTec Domain Name Services Added Request
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(Only use this section for Domain Accounts - Plans # 4,5,7,8)

	New Domain Name Internic Registration - $70.00/1st 2 Years
	Transfer Domain Name Internic Registration - Free

Number Domain Names

Main Domain Name Included In "Domain" Hosting Plans - Free Unlimited Secondary Domain Names - $30.00/3 months Please Specify Main & Secondary Domain Names and Directory Example: Main Domain Name(Enter) Root Directory(Enter) Space(Enter) Secondary Domain Name(Enter) Sub-Directory(Enter) Space(Enter) If you have trouble filling out this form as presented, please write down what you would like in plain English,  and we will make it so.

CyberTec Web Services Added Request
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	Web Site Design Service - $380.00/10 Hours
	Unlimited Local Dial Up Internet Service - $60.00/3 months
	Cybertec Resumes Online - $15.00/3 months

CyberTec Additional Web Space Added Request
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Additional MB

Unlimited web space available - 10 MB - $15.00/3 months                                                   25 MB - $30.00/3 months