Personal Information:
Contact name: ________________________ Company:____________________
Address:_________________________City____________State___ Zip:_______
Phone:___________________________FAX:_____________________________
E-mail address:______________________________________________________

Account Information:
(Primary username is for both FTP and Email. Additional usernames are for email only)
Primary Username:__________ Password ___________ Forwarding: _______________
2ndary Username:__________ Password ___________ Forwarding: _______________

Directory or Domain name requested: ________________________________________
(Check at Better-WhoIs.com)

Alternate Domain Choices: ________________________________

Additional usernames for e-mail:
(Please provide passwords or forwarding information)
________________________________
________________________________
________________________________

NEW: Resellers can now request unlimited tertiary domain names, of the form Keyword.Yourdomain.Com. (These names will be synonymous with your primary domain name.) E-mail gvelez@iwhome.com for details, or list requested names here:

Tertiary domain aliases: _______________________________________

Account includes 50Mb of space on a dedicated Web Server and 10 POP accounts, plus all other features of a virtual domain account. The URL will be of the form http://YourDomain.com Unlimited aliases of the form http://Keyword.YourDomain.com may be requested at no additional charge. Unlimited license is granted to add commercial home pages and subdirectories within this area. Additional domain names can be added at 1/2 of our retail prices (see below). All virtual domains include:

Detailed weekly usage report


Cgi-bin direct access and pre-prepared scripts


Webglimpse full-text search


Public FTP area for downloads


mSQL database


Cybercash software


Stronghold secure server


Minivend shopping cart


5 Keyword domain aliases


25Mb additional space, 5 additional POP accounts


Unlimited e-mail forwarding

http://YourDomain.com

	Setup Cost	Periodic Cost	Price Break
Reseller's Account	$80 setup	$60/mo or $600/yr	none
Additional Virtual Domains (50Mb of space)	$15/mo or $150/year Lowers to $10/mo, $100/yr with greater numbers.
BulkRegister Name Registration	$20 per domain	Annual renewals	none
All other services	1/2 of retail	1/2 of retail	varies

Please indicate setup or yearly fees for each account requested.

Total Amount Enclosed:	___________________
Date:	___________________
Who will maintain this site?	___________________
How did you hear about us?	___________________

Signature: _______________________________ 


Please mail or fax this form to:

Internet WorkShop
212 S. Meridith Av
Pasadena, CA 91106

 / 520-440-1420 / (FAX) 792-7377