Steadfast and Sure
Hosting Registration Form

Instructions for payment by check:

(1) Please fill out this form. (2) Print it by right clicking on the form. Click PRINT (3) Enclose a check for the correct amount. (See Chart) (3) Mail form and payment to: Anchor WebHost 1149 Wolcott Rd Wolcott, CT 06716	Hosting Plan Rates
	Check the Plan you wish to buy	Monthly Pmt	3 Months Pmt	6 Month Pmt	Yearly Pmt
	Starter Plan	N/A	N/A	$40.00*	$60.00
	Economy Plan	N/A	$40.00*	$70.00*	$120.00
	Standard Plan	$15.00	$45.00	$90.00	$180.00
	Silver Plan	$20.00	$60.00	$120.00	$240.00
	Gold Plan	$30.00	$90.00	$180.00	$360.00

* Includes a one time Startup Fee of $10.00 for the first payment only. Fee is waived on Yearly Payments.

*Full Domain Name* www.
*First Name*
*Last Name*
*Organization*
*Street Address*
*Address (cont.)*
*City*
*State/Province*
*Zip/Postal Code*
*Country*
*Phone Contact*
*E-mail*

DISCLAIMER:
Accounts will be established on a good faith bases when check is received. If check will not clear, then the account will be suspended until funds are secured. Invoices are due upon receipt.

Steadfast and Sure Hosting Registration Form

Steadfast and Sure
Hosting Registration Form