Secondary Site Sign-Up Form

*Full Name:

*Company Name:

*Company Phone:

*Email Address:

Company Address

*Address:

*City:

*State/Province:

*Postal Code:

*Choose Website Package:

*Monthly price does not include one-time $995 startup fee

Site includes hosting a new domain name or your current web address, annual renewal of one domain name (.com, .net, .biz) if transferred to host account, use of the PagePilot web system, content, bandwidth, system updates, training and technical support. Internet access not included. Service may be cancelled at any time with 30 days written notice-see http://terms.online-access.com for full terms and conditions. PagePilot websites include a 100% money-back guarantee based on user's complete satisfaction for the first 90 days of subscription.

*Billing Options

Use my existing billing method

Contact me for alternate billing.

*I understand and accept above terms and authorize billing of the website service package selected and requested above

Yes

*Authorized by (Name):

*Primary Subscriber Requesting Second Site:

Submit

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