WEB Space Order Form

Important: When you have filled out the form to your satisfaction, click on the SEND button at the very bottom of the form to enter your order.

Please Enter Your Information Here:

- E-Mail Address

- Name

- Street Address

- City

- State/Province

- ZIP/Postal Code

- Country

- Daytime Phone

- Type Of Business

- Internet Provider

- Web Brouser Used

WEB Space Order:

MOS Price ea. (At $35.00/Mo.)

One Time Page Set-Up Fee On PegaNet(sm) (This Is A $50.00 Charge For All Home Page Orders)

Individual Internet Access On PegaNet(sm) At $15.00 Per Month

Subtotals

- Individual Internet Access

- Home Page Web Space $35.00

- One Time Set-Up Fee Of $50.00

- Subtotal Order

- Florida Residents Add 6% Sales Tax

- Total Order

Initial Here For Price Quote OnlyThank You!

We Will Contact You With An Estimate Via Email

Credit card type:
VISA MasterCard American Express Discover

- Credit Card #

- Name on card

- Expiration Date

- (select to send order) - (select to clear the form)

[PEGASUS] Return To Peganet(sm) And Pegasus Software & Imaging

Copyright 1995 Pegasus Software & Imaging And Chris Michaels