Web Hosting Service Form

Signing up is as easy as 1-2-3...
  1. Just print out a hard copy of this form.
  2. Fill out form completly
  3. Fax back to (718) 236-8338, or mail to:

Skywiz Internet Services
7400-20 Ave.
Brooklyn, New York 11204

Customer Information(Bill to):

Name/Contact:_______________________________________________________

Company/Dept:_______________________________________________________

Address:____________________________________________________________

City:_________________State__________Zip___________Email____________

Home phone___________________Business phone_____________Fax_________

Payment Information

Method of payment:_____Credit card_____Check_____Cash_____Money order

Name on credit card_______________________Billing Address________________

Account number_________________________Expiration date_________________

Signature________________________________________date_______________

This agreement between Skywiz Internet Services and_____________________________ is for a period of 12 months at a rate of only 24.95 per month.

one time setup=49.95
24.95 X 12= 299.40
Total=349.35













This site is always under construction and development.
Please excuse any typographical errors and/or inappropriately marked items.
Thank you for understanding.

©1998 Skywiz™ Internet Services