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MOL Web Site Online Order Form

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

Yes, this is a secure transaction.

Upon approval, your (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 with an email address of healer @

Items in red are required



Web Site Name:
Your Name:
Your Address:


E-mail address:
Site Title:


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 @ 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:  
Card number:    

Card Security Code:

Expiration Date:         
Card Billing Address:





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 Web Site with the information I have provided.  


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