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Secured Online Order Form

 

    

         Name:                      

        Street Address:       

        City, State, Zip:           

        Telephone:                Fax:  

        E-Mail Address:       

        Domain Name:    WWW..

        Is This A New Domain?       

        Password Desired:              

        Payment Type:                    

        Name On Card:                    

        Credit Card Number:           

        Expiration Date:                    Month:      Year:

        Choose A Plan:         Junior $14.95

         (Check One)           Teen $19.95       Senior $34.95

        Other Services:    Real Audio $5.00  Real Video $5.00  

                                        SSL $15.00 Setup

        Web Page Design: Toy Box $25.00  Play Ground $50.00

                                        Shopping Mall $125.00

There Is A One Time Setup Fee Of $25.00 On All Plans

By Submitting This Order You Have Agreed
To The Terms Stated On The Previous
Agreement Page.

   

3480 Uphill Terrace
Jacksonville, Florida   32225
(877) 812-4479        Fax  (904) 374-6153

Send mail to webmaster@jratax.com with questions or comments about this web site.
Copyright 2001 John Rhodes Associates