Stickdog- Broadband Solutions

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Internet Access:

·Covad Circuit Transfer
·Dial-up Internet
·Express DSL
·Enhanced ADSL (PPPoE)
·Enhanced ADSL (DHCP and Static IP)
·Enhanced IDSL and SDSL
·Enhanced T1

Onsite Support and Service:

·PC Support
·LAN Service

Telephone Services:

·Long Distance Authorization
·Teleconferencing

Web Services:

·Domain Name
·Web Hosting
·Web Design

Voice over IP:

·Voice over IP

Domain Services Order Form

Prices on this page expire 01/31/04

05-18-2012

Company Name:

First Name:

Last Name:

E-mail address:

Telephone Number:

Street Address:

City: State: Zip:

Billing Address: same as the Service Address

If different from the Service Address:
Billing Address:
City: State: Zip:

Domain Name Services

Domain Name Requested: http:// .

Registration Price

2 year $56.00

5 year $126.00 *save 10%

10 year $238.00 ** save 15%

Services
Option	Activation	Monthly Fee
DNS Primary+ Secondary	$49	$5
DNS Secondary	$49	$3
Domain Name Parking	n/a	$1

Subscriber agrees to use this service in compliance with all applicable laws and to indemnify and hold Stickdog harmless for any loss incurred by Stickdog or Stickdog’s suppliers as a result of Subscriber’s use of Stickdog’s service. Subscriber agrees to pay fees in accordance with Stickdog’s rate schedule listed above, and revisions thereto, provided that Stickdog provides notice to Subscriber of any rate increase at least 60 days prior to next payment due date.

Personal Identifiers will be used in lieu of your signature on this online form. This information is required for processing.

Birth Month*: 2 digit Day*:(example "01") 4 digit Year*: (example 2002)
Mother's Maiden Name*:

Stickdog · 143 A Church St NW, Vienna, VA 22180. · (703) 319 1700 · Fax: (703) 319 1894 · sales@stickdog.com