Billing Information:
Name: _______________________________________ Date: __________________
Address: ____________________________________ Phone: _________________
City: _______________________ State: ___________ Zip: _______________
Website Hosting Plan:
______ Personal Website Hosting - $19.99/month (500 MB storage, 10 GB/month bandwidth, 10 included e-mails)
______ Professional Website Hosting - $29.99/month (1000 MB storage, 20 GB/month bandwidth, 30 e-mails)
______ E-Commerce Website Hosting - $39.99/month (2000 MB storage, 50 GB/month bandwidth, unlimited e-mails)
Optional Information:
______ I would like Iceberg Hosting to contact me about Website Design
______ I am interested in purchasing additional services (storage space, bandwidth, e-mail, ftp accounts,
subdomains, databases) with my website hosting
______ I am interested in placing an advertising link to my website on Iceberg Hosting’s website
I have read and agree to Iceberg Hosting’s Terms of Service Agreement, which is outlined on the reversed side of this document.
Signature: _____________________________________________________ Date: __________________
Print and mail this form to:
Iceberg Hosting
117 South Oregon Ave.
Morris, MN 56267
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