General Information
Name:
Address:
City:
State:
Zip:
Company:
Phone (Day):
Phone (Night):
Referred by:
Current Email:
Email Accounts Primary Alternate Password (5 to 8 Characters)
Account #1
Account #2
Account #3 ( $2.50/mo.)
Account #4 ( $2.50/mo.)
Account #5 ( $2.50/mo.)
Payment Information
Operating System:
Service you are requesting:

Plus additional e-mail accounts, each @ $2.50/month

Total To Be Billed:

Payment Type: VISA MASTERCARD
Credit Card #:
Expiration Date:

Cardholder Name:
Address:
City:
State:
Zip:

AUTOCHARGE PAYMENT PLAN

I hereby authorize PrismWeb.Net to bill my credit card the total account charge, plus setup fee, plus any hourly overages as determined by the type of account and periodic rate for which  I have applied. I understand that the prices are subject to change without notice, and that I have the ability to change my account status at any time.  I understand that my credit card will be automatically billed on a monthly basis as pre-payment for services to be provided the following month. I understand that PrismWeb.Net. may continue to charge the card provided, for all fees and charges due until I change my payment method or cancel my account. I also understand that if I wish to discontinue this automatic charge arrangement, I must also provide PrismWeb.Net, Inc. with 30 days notice of my request to discontinue the automatic charge arrangement. I hereby agree to these terms.

NOTE: Billing will occur on the 1st of the month. If the 1st is on a weekend or on a holiday that PrismWeb.Net is closed, the billing will be done in ADVANCE on the day preceding. If for any reason your credit card is denied, you will be subject to a service charge of $10.00 and your account will be disabled immediately. It is up to you as the credit card holder to inform PrismWeb.Net of any changes regarding your card; i.e., replacement, new expiration date, etc. The card will not be run again until such time you have contacted us. If you do not contact us within 10 days, your account will be deleted from our servers and a $25.00 fee will be required - in addition to the outstanding amount owed - to have your account reconnected.
LIMITATION OF WARRANTY
PrismWeb.Net, Inc. will not be held responsible for any type of data corruption or loss associated with the use of its services. Virus Scanning and other related issues are the sole responsibility of the above signed. In the event of malicious or unethical use of PrismWeb.Net, Inc.'s resources ( as determined by PrismWeb.Net technical support), an account may be suspended or terminated without notice. In no event shall PrismWeb.Net be liable for any direct, indirect, special, or consequential damages, or lost profits arising from or related to the use of it's services thereunder or any breach thereof even if Prismweb.net has been advised of the possibility thereof. PrismWeb.Net MAKES NO WARRANTIES, EITHER EXPRESSED OR IMPLIED, AS TO ANY MATTER WHATSOEVER. INCLUDING BUT NOT LIMITED TO THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE. CLIENT ACKNOWLEDGES THAT PRISMWEB.NET HAS MADE NO STATEMENTS, REPRESENTATIONS OR WARRANTIES OF ANY KIND WITH RESPECT TO PRISMWEB.NET'S SERVICES OTHER THAN THIS AGREEMENT.

BY SUBMITTING THIS FORM, YOU ARE STATING THAT YOU HAVE READ THE ABOVE CONDITIONS AND OUR ACCEPTABLE USE POLICY AND ARE AGREEING TO ADIBE BY THEM.