Clearlight Communications

Account Order Form

Please read our Terms & Conditions before placing your order.

Step 1. ACCOUNT INFORMATION
Basic Account - US$9 per month  
Business Account - US$14 per month  
Professional Account - US$29 per month  

Special Needs:
       

Step 2. DOMAIN NAME INFORMATION:

Registration:   New Transfer Existing Domain 
Domain Name:
Alternate Domain Name:
   
Step 3. CONTACT INFORMATION (fields marked ** are required)
Company Name:
Contact Name: **
Email Address: **
Address: **
City: **
State/Province: **
Zip/Postal Code: **
Country: **
Day Phone: **
Fax:
    
Step 4. BILLING INFORMATION
Payment Method: Credit Card  Check or Money Order
Credit Card Type: AMEX  VISA  MC  DISCOVER
Credit Card Number:
Expiration Date:
CVV Number:
Name of Card Holder:
Credit Card Billing Address:
Service Period: Automatic Monthly Credit Card Billing
3 Months
6 Months (receive the 7th month FREE)
Annual (receive the 11th and 12th months FREE)
   
Step 5. BILLING CONTACT (if different than the primary account contact):
Billing Contact:
Billing Address:
Billing Telephone:
Billing Email Address:
   
 
Copyright 1995-2016 Clearlight Communications, Mancos, Colorado
Toll Free Telephone US: 877-801-3231 * International: +1.3306771911 * email: sales@clearlight.com