MassageOnline.NET

Massage Resources - listings of professional massage therapists, product resources, massage schools, and other useful information for massage therapists and the clients seeking a massage therapist

MOL Web Site Online Order Form

Please enter the following information and complete as many fields as possible.

Upon approval, your MassageOnline.net (MOL) web site will be added to the MOL site. Please do not use common Massage terms as a web name as most have been reserved for use within our web site. The best name to use would be your last name or first initial and last name (i.e.- smith, bsmith) or company / nickname (i.e.- healer, wizard, etc.). Your web site address would then be www.MassageOnline.net/healer with an email address of healer @ MassageOnline.net.


Items in red are required.

Web Site Name:

http://MassageOnline.net/

Your Name:
Titles:
Telephone:
FAX:
Your Address:
E-mail address:

Site Title:
Keywords:
Short Description:

Select Billing Option:	One Year in advance @ $4.95 US per month = $59.40 Total
	Two Years in advance; get two months free = $108.90 Total

Your web site comes with a forwarding email account. This forwards all emails sent to web_site_name @ massageonline.net to the email address you have entered above. Select the option below if you want a full POP3 email account instead of the forwarding account above. See POP3 details >>

Optional POP3 Email:	One Year in advance @ $4.95 US per month = $59.40 Total
	Two Years in advance; get two months free = $108.90 Total

Card Information:	Yes, this is a secure transaction. See details here >>
Name on card:
Billing:
Card number:
Card Security Code:
Expiration Date:
Card Billing Address:
State:		Zip:

Additional Information:

This information will be part of the listing and will be placed on the site exactly the way you enter it here.

If you have additional information or photos - you will have a chance to send that to us before we create the web site.

Submit Child Web Order:

I have reviewed the Web Site details / FAQs and hereby authorize TeleComputers Services to charge my credit card and produce my MassageOnline.net Web Site with the information I have provided.

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