I. Business Information

    Your E-Mail address:              





    Legal Business or Corporate Name: 

Your Name:           



DBA Name:           



Street Address:     



		    



City:               



State/Province:     



Zip/Postal Code:    



Country:            

Telephone:
Fax:
In Business since:
Description of Business:
Organizational Structure: Sole Proprietorship Corporation (Sub-Chapters "C" or "S") Foreign Corporation ("Ltd.") Partnership Limited Liability Company Non-Profit or Publicly Supported Organization
Your Title: President Vice President Owner Partner Manager Other
Federal Tax Account number:

(Do Not Enter a Social Security Number Here)

II. Owner or Principal Officer's Personal Information

Firstname:          



Lastname:           



Home Address:       



		    



City:               



State/Province:     



Zip/Postal Code:    



Country:            

Home Telephone:
Home Fax:
Contact Email:
Social Security number: Your mother's maiden name ( for security purposes):

(This information is used for identifying purposes only!)

Referred by:

NOTE: This is the person/organization that referred you to BeOnTheNet. Please Enter their BeOnTheNet Account if you know it.

III. Service Programs

Please check the type of Service you are applying for:

Bronze Service - Quarterly Fee: USD $60.00

One-Time Set-Up Fee on Bronze Service Program: US $35.00.

• One Quarter Payment $60.00 Plus Set Up $35.00 = $95.00
  Six Month Payment $99.00 Plus Set Up $35.00 = $134.00
  One Year Payment $179.00 Plus Set Up $35.00 = $214.00
  

Silver Service - Quarterly Fee: USD $125.00

One-Time Set-Up Fee on Silver Service Program: US $55.00. (Includes Page Creation)

• One Quarter Payment $125.00 Plus $55.00 Set Up = $180.00
  Six Month Payment $225.00 Plus Set Up $55.00 = $280.00
  One Year Payment $400.00 Plus Set Up $55.00 = $455.00
  

Sterling Silver Service - Monthly Fee: USD $65.00

One-Time Set-Up Fee on Sterling Silver Service Program: US $95.00. (Includes Page Creation)

• One Month Payment $65.00 Plus $95.00 Set Up = $160.00
  One Quarter Payment $175.00 Plus $95.00 Set Up = $270.00
  Six Month Payment $300.00 Plus Set Up $95.00 = $395.00
  One Year Payment $549.00 Plus Set Up $95.00 = $644.00
  

Gold Service - Monthly Fee: USD $110.00

One-Time Set-Up Fee on Gold Service Program: US $85.00.

• Additional Charges for Dynamic & Static Pages will be quoted after receipt of material. Approximate Cost is $50.00 per Dynamic Page and $25.00 per Static Page. If Information is received as an electronic file a 20% discount will be applied.
  

• One Month Payment $110.00Plus $85.00 Set Up = $195.00
  One Quarter Payment $300.00Plus $85.00 Set Up = $385.00
  Six Month Payment $549.00 Plus Set Up $85.00 = $634.00
  One Year Payment $999.00 Plus Set Up $85.00 = $1084.00
  

Platinum Service - Quarterly Fee: USD $390.00

One-Time Set-Up Fee on Platinum Service Program: US $175.00. (Includes Registering Your Domain Name - But not Internic Fee

• Additional Charges for Dynamic & Static Pages will be quoted after receipt of material. Approximate Cost is $50.00 per Dynamic Page and $25.00 per Static Page. If Information is received as an electronic file a 20% discount will be applied.
  

• One Quarter Payment $390.00Plus $175.00 Set Up = $565.00
  Six Month Payment $725.00 Plus Set Up $175.00 = $900.00
  One Year Payment $1300.00 Plus Set Up $175.00 = $1475.00
  

IV. Account Set Up:

Please complete the following information so we can properly setup your account. You will need to select an account name/user name. This account name along with a password which we will assign you will become the key to your account.

This 'account name' will also become the name of your web directory, as well as the email path to your autoresponder. Example:

• Your URL would be: http://www.beonthenet.com/account_name/...
• Your email path would be: anyname.accountid@beonthenet.com
• Your autoresponder path would be: document.accountid@beonthenet.com

List below your five choices for an account name:

1. Choice:
   
2. Choice:
   
3. Choice:
   
4. Choice:
   
5. Choice:
   

VIII. Selection of Payment

Note to Non-U.S. applicants:

Quarterly charges for Bronze Fee are only possible to a credit card. The recommended form of payment for non-U.S. clients is either a credit card, Bank cheque drawn on US bank or American Express international money order.

Please select your preferred type of payment below:

Please charge Fee to my credit card.
Please make checks payable to BeOnTheNet, Inc.
Please process quarterly drafts against my checking account.

Note: quarterly drafts are only possible against US accounts.
If you selected this option, we will forward an authorization form to the email address specified.

If you prefer, you may either fax your credit card information to (631)980-4131 or phone us at (631) 351-7699 - 1-888-632-9728.

My credit card information is included below.
I will fax my credit card information. Fax to: (212) 213-0784.
I will phone your office with my credit card information.

Important: We will not process your application for service until we receive full payment for your service/account setup. Payment via credit card ensures immediate account setup.

Credit Card Information:

Type of card: Visa MasterCard

Name on card:
Card number:
Expiration date:

Click Here to acknowledge that you have read and agreed to the Membership Rules :

Click here to "sign":