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In order to assist you better, please complete the following form.
All information will remain confidential.

Please note: Although it is most unlikely that you will experience any problems responding to this form, certain non-standard browsers will not respond properly. If you experience any difficulties, (or if you are not using a forms-capable browser) you may email your response to this form to: sales@visualhorizons.net

VISUAL HORIZONS DOES NOT HOST ADULT ORIENTED SITES.

VISUAL HORIZONS DOES NOT ALLOW THE SENDING OF UNSOLICITED EMAIL (SPAM).

The FIRST OFFENSE will result in an AUTOMATIC TERMINATION of your account.

Domain Name

Domain Name: Check Domain Name

Customer Information

Name:
Company Name:
Type of Business:
Address:
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State/Province: (Please use 2 digit abbreviation)
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Who referred you to Visual Horizons? Please enter their full name or their Domain Name:

Web Designing Packages

Beginner Web Package	Number Of Pages:
Standard Web Package	Number Of Pages:
Advanced Web Package	Number Of Pages:

Web Hosting Options Universal Currency Converter

Plan 1	$28.00/month	Set-up $30.00	Total Due $58.00
Plan 2	$50.00/month	Set-up $30.00	Total Due $80.00
Plan 3	$94.00/month	Set up $30.00	Total Due $124.00
Plan 4	$140.00/month	Set up $30.00	Total Due $170.00

** ALL Hosting Options support FrontPage Extensions.

E-Commerce Solutions

E-Commerce Business Package

Number Of Pages:

Please E-mail me more information about Visual Horizons' Asian Internet Ventures !

Thank you for using Visual Horizons, Inc.

Visual Horizons Does Not Host Adult Oriented Sites
Visual Horizons Does Not Allow Sending of Unsolicited Email (SPAM)
First offense will result in immediate termination of account.
If this occurs the unused portion of your account will not be refunded.
Visual Horizons reserves the right to cancel your service with NO refunds should either of the above occur.

Web Hosting | Web Design | E-Commerce | Asian Internet Ventures

For More Information Contact:

information@visualhorizons.net
sales@visualhorizons.net