DNS4Me Print and Fax Order Form

RhinoSoft.com
P.O. Box 53
Helenville, WI  53137  U.S.A.
Sales: +1 (262) 560-9627
Voice: +1 (262) 560-9627
FAX:   +1 (262) 560-9628

Please complete, print and fax this order form to +1 (262) 560-9628
Please fax only page 1.

DNS4Me Service

Domain(s) (subject to availablility):    
Unit Price:
Sub Total:   
Sales Tax:   
(Sales Tax is 5.5% for Wisconsin Customers Only)
Grand Total: 

NOTE: Please complete the following Customer & Credit Card
Information, ensuring that all information is completed
accurately.  The accuracy of your email address is extremely
important as your registration details are sent to you via email.

First Name:                
Middle Name:
Last Name:                 
Company:                   
Name to appear on license: 
Address1:                  
Address2:                  
City/Town:                 
State/Region:              
Zip/Postal Code:           
Country:                   
Phone:                     
Fax:                       
Email Address:             

Credit Card Type:        
Note:  We accept Mastercard, Visa, American Express and Discover
Credit Card Number:      
Expiration Date (MO/YR): 
Name on Credit Card:     

Alternative Payment Method: 

NOTE: If you wish to place your order and utilize an alternative
payment method, please leave the credit card details blank and
enter Check/Money Order, Purchase Order or Telegraphic Transfer.
Please be advised that you will not be issued registration details
until payment has been received.  An additional $25 must be
added for Telegraphic Transfers.

DNS4Me includes free email technical support and free
upgrades for a period of one year from the date of purchase.

To purchase additional tech support and upgrade protection,
please call RhinoSoft.com at +1 (262) 560-9627.