Inter7 Support Order Form

STEP 1: Please TYPE in the following information to the best of your knowledge. STEP2: Print this page STEP3: Sign where applicable STEP4: Fax to (815) 776-9488 or Scan and email image to team@inter7.com

Billing Information
Your Name/Technical Contact:
Company Name:
Company Address:

City:		State:
Zip or Country Code:		Country:

Contact Information
Work Phone:		Cell Phone:
Pager:		Home Phone:
Working Email:		Group Email:

Add e-mail address to the Inter7 mailing list? Yes No

Credit Card Information	(Visa, MasterCard, & AmericanExpress.)
Name as it appears on card:
Billing Address:
City, State, Zip:
Credit Card Number:
Expiration Date (mo/yr):	/ CVV Security Code on Back of Card

After printing, please initial the following payment policy:
Inter7 support services are based on an hourly rate of $115/hour during business hours and $200/hour during off hours. Credit card fraud is a felony. Inter7 will prosecute anyone attempting to misuse a credit card number. _________

Card Holder's Signature:_____________________________
Today's Date:_____________________

Server Information
Server IP:		Root Password:
Login:		Password:

Additional requests or comments

Print and FAX to 815 776 9488