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DynIP Canadian Registration Form
DynIP Registered Customer
| First Name |
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Last Name |
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| Company |
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| Address |
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| City |
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State/Prov. |
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| Zip/Postal Code |
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Country |
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| Telephone |
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| E-mail address
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Registration Key
(from About Tab)
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Service Options
| Quantity (yrs.)
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Service
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Price (CAN $ /year)
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Total |
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DynIP Basic |
$49.95 |
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DynIP Pro
Domain Name: |
$72.95 |
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DynIP Enterprise Edition
Domain Name: |
$219.95 |
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Subtotal |
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| Plus 13% Tax (GST/HST #898246574RT) |
13% |
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| Total Enclosed
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Payment Method
Credit Card Information
| Card Holder Name |
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| Card Number |
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Expiry Date |
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| Signature |
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| Please mail or fax the completed form to: |
CanWeb Internet Services Ltd.
1086 Modeland Road
Building 1010 - Suite 201
Sarnia, ON, N7S 6L2, CANADA
Fax: +1 (519) 332-6464 |
You will be sent confirmation of your payment by e-mail. Thank You!
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