MetaLINK Technologies, Inc. - Web Hosting Order

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Please fill out the following form so that we may process your order. Make sure that each of the questions are answered, as any blank answers will delay the signup process. If you have any questions, please call our Sales department at 1-888-999-8002 or 419-782-3472.

Full Name:

Company Name:

NOTE: If being used for business purposes

Address 1:

Address 2:

City:

State:

Zip:

Phone Number:

Birthdate:

NOTE: Used for account verification purposes

How did you hear about us:

Friend, Family, or Associates's Email Address:

Domain Name:

NOTE: If you already have a domain name registered, please type it in the field provided. If you do not currently have a domain name, please register one here.

Type of Account:

Package:

NOTE: If you are not sure which package is right for you, please look over our packages here.

Administrator Email Address:

NOTE: If no address if given, all e-mails will be sent to username@metalink.net

Username Choice 1:

NOTE: The username will be used to access the PLeSK interface. A password will be randomly generated and sent to you once the account is set up.

Username Choice 2:

Username Choice 3:

Comments:

Required field

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