You DO NOT need a credit card to complete this form.
All entry fields with the red asterisk (*) are required.

THERE ARE FOUR STEPS TO SIGNING UP:

1. Select Website Series, iOFF Level and Additional Services.
   For "Series" select "NEW DESIGN" for a custom website.

2. Provide up to nine (9) possible domain names to be used.

3. Provide E-mail Addresses (Usernames, Passwords, Notes).

4. Provide Business Location, Contact and Billing Information.
   You may also include any REFERRAL Codes, comments or additional instructions.

Step 1 of 4:
SELECT WEBSITE SERIES, iOFF LEVEL and ADDITIONAL SERVICES

Per Quote Services Include: Flash Animation, On-line Custom Database, Digital Photos.
Domain Name $30 per year
Secure Server Certificate $240 per year
These services will add to your monthly total. Please contact us for information.

WEBSITE SERIES Select only one. Choose "NEW" for a new design.	iOFF LEVEL Please select only one. This form uses automatic calculation.	ADDITIONAL Select all other services you want included in your site.
SERIES: 0001 0002 0003 0004 0005 0006 0007 0008 0009 NEW DESIGN COLOR: [The preferred predominant color of website] 0001 0002 0003 0004 0005 0006 0007 0008 0009	iOFF BRONZE Up to 25 web pages, 10 email addresses, For $75 per month.  iOFF SILVER Up to 60 web pages, 25 email addresses, For $95 per month.  iOFF GOLD Up to 110 web pages, 100 email addresses, For $125 per month.	Shopping Cart $15.00 per month  Merchant Gateway $10.00 per month
Total Monthly Subscription Amount: This amount is the total monthly subscription fee that must be paid on the first of each month.

Step 2 of 4:
PROVIDE UP TO 9 DOMAIN NAMES FOR REGISTRATION

If you already have a registered domain name that you want to use, you may enter it here.

This is based on "order of preference." We will first check for choice 1, then choice 2, then choice 3, etc., until we find the name that is available.

Domain Choice 1:	*
Domain Choice 2:
Domain Choice 3:
Domain Choice 4:
Domain Choice 5:
Domain Choice 6:
Domain Choice 7:
Domain Choice 8:
Domain Choice 9:

Step 3 of 4:
PROVIDE UP TO 9 E-MAIL ADDRESSES (Username, Password, Notes)

After we register your preferred domain name, your username will be attached to the domain names to form your e-mail address, e.g., Username@DomainName.Com. Just as with your domain name, it is better to have an e-mail address that is short and easily understood.

Your password should be a word that you will be able to easily remember. You can use a combination of letters and word, but it should start with a letter and have no spaces within it. Although you can create a longer password, it is better to try to keep in within 8 digits.

You can use the "NOTES" space to give the e-mail addresses to which mail sent to each e-mail must be forwarded. For example, if you already have a YourName@yahoo.com e-mail address and you prefer to continue using it, you could still create a new e-mail address at your domain, for example, sales@MyDomain.com and have it forwarded to YourName@yahoo.com. All mail that your customers send to sales@MyDomain.com will automatically go to Yourname@yahoo.com

EMAIL Username		EMAIL Password	EMAIL NOTES
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7.
8.
9.

Step 4 of 4:
PROVIDE CONTACT INFORMATION (Locations, Business Contact "MiSR", Billing)

PHYSICAL BUSINESS If you have more than one business location, you should only provide the physical location to your main branch or the branch for which this sign-up is being executed.
Business Name:	*
Business Phone:	*
Business Fax:
Business Type:
Business Address:
Business City:
Business State:
Business Zip:
Copy Address to:	MiSR   Billing
Business Contact (Main iNTELLESIS Subscriber Representative "MiSR") The individual responsible for changes to this account. Name and other particulars must be filled in. Address can be left out if same as Physical Business.
MiSR Full Name:	*
MiSR Phone/Cell:	*
MiSR Job Title:	*
MiSR E-mail:
MiSR Address:
MiSR City:
MiSR State:
MiSR Zip:
Back-up MiSR:	Enter the name, phone, address and related instructions about other individuals who are authorized by the MiSR to effect changes on this account.
BILLING INFORMATION You will be billed only after the website has been published.
Billing Method: [select one]	By E-mail  US Postal  Credit Card
Billing E-mail:
Billing Name:
	Don't fill out address if same as Physical Business address or Business Contact address.
Billing Address:
Billing City:
Billing State:
Billing Zip:
Billing Phone:
Billing Fax:
COMMENTS: QUESTIONS: INSTRUCTIONS: