Order Form


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 $120/hour during
business hours and $205/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


Copyright © 2012