Servzilla Web Presence Service On-Line Order
 
* Required Fields
Customer Name:*
Company Name:*
Address:*
Suite:*
City:*
State / Province:*
ZIP / Postal Code:*
Country:*
Telephone:*
Fax:
E-Mail:*
 
Presence Package Type
Service:
Your Requirements:
Hosting Level
Extra Email Accounts:
$5.00 each or blocks
of 5 for $20.00
Comments or Custom Services
Our order process is two stage. Once this form has heen submitted we will process the basic
information. In the second stage we will e-mail you an additional Information Sheet to finalize
setup details, and verify the required information.