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BUSINESS eMAIL HOSTING ORDER

AFFILIATE INFO
Affiliate Business Name + Franchise # (if applicable)*
Your Name*
eMail*
Phone*
ABOUT YOUR CUSTOMER
Company Name*
Domain*
SELECT eMAIL HOSTING PACKAGE
Select Type of eMail Hosting*
Number of eMail Addresses Needed. (Cost is per Account / Monthly) Quantity*
Price: $4.00
Number of eMail Addresses. (Cost is per Account / Monthly) Quantity*
Price: $12.00
MONTHLY COST (Billed To Affiliate Account)
MONTHLY
$0.00
BILLING FREQUENCY*
Thank you! We appreciate your Business.
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SUPPORT | Charlotte

Remit: P.O. Box 77163
Charlotte, NC 28271

support@bigheadwebhost.com
p. (980) 800-9950

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