PlanetDNS US & International Order Form

Customer Information

First Name	Last Name
Company
Address
City	State/Province
ZIP/Postal Code	Country
Telephone
E-mail Address

Authorization Code

-

-

-

The authorization code is required only when ordering PlanetDNS Standard, Pro or Enterprise services. The authorization code is available from the PlanetDNS Client software under the “Account” tab.

Service Options

Quantity	Product/Service Description	Price (US $)	Total
	PlanetDNS Standard Service PDNS-STD-D00-N01	$24.95/year
	PlanetDNS Pro Service PDNS-PRO-D01-N01	$59.95/year
	PlanetDNS Enterprise Service PDNS-ENT-D03-N01	$299.95/year
	5MB Mail Store & Forward Service PDNS-STF5-D00-N01	$39.95/year
	10MB Mail Store & Forward Service PDNS-STF10-D00-N01	$69.95/year
	25MB Mail Store & Forward Service PDNS-STF25-D00-N01	$149.95/year
	PlanetRemote Standard PDNS-REM-STD	$39.95
	PlanetRemote Plus PDNS-REM-PLUS	$59.95
		Subtotal:
		Total Enclosed:

Payment Method (Please check one)

Money Order

Check

MasterCard

Amex

Visa

Credit Card Information (skip if paying by check or money order)

Card Holder Name
Card Number	Expiry Date
Signature

Your credit card will be billed by NewAce Corporation in Canadian dollars. The exact exchange rate will appear on your credit card statement.

Please send the completed form to:         NewAce Corporation

P.O. Box #456 STN MAIN

Sarnia, ON N7T 7J4

Canada

                                                            Fax: +1 519 336-4046

Thank You!