Application to Become
a
Marketing Partner

Please supply all requested information so we can process your application without delay.

You will receive confirmation and a unique BeOnTheNet Account number upon receipt of your application.

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:  

Your Title:                

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:
(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:

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

Silver Service - Quarterly Fee: USD $55.00
One-Time Set-Up Fee on Silver Service Program: US $50.00.
Gold Service - Quarterly Fee: USD $99.00
One-Time Set-Up Fee on Gold Service Program: US $50.00.
Your Own Basic A Server Service

         Click Here For Full Details- Quarterly Fee: USD $200.00

One-Time Set-Up Fee on Basic Server A Program: US $75.00.

IV. Account Set Up:

Please complete the following information so we can properly set-up 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:

List below your five choices for an account name:

    

  1. Choice:     
    

  2. Choice:     
    

  3. Choice:     
    

  4. Choice:     
    

  5. Choice:

V. Domain Registration

Domain to be registered:

     First Choice: 


    Second Choice: 


     Third Choice: 


    Fourth Choice: 


     Fifth Choice:

VI. Virtual Domain Service

(Section IV. Domain Registration must be completed) Virtual Domain Service.

Addressing Schemes Under Virtual Domain Service:

VIII. Selection of Payment

Note to Non-U.S. applicants:

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 quarterly Fee to my credit card.
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 (516) 549-9728 or phone us at (516) 351-7699 - 1-888-632-9728.

My credit card information is included below.
I will fax my credit card information. Fax to: (516) 549-9728.
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: 


Name on card:        

Card number:         

Expiration date:

Click here to acknnowledge that you have read and agree to BeOnTheNet's Marketing Partner Agreement.

***Terms of Service***
Please read before continuing.
Click here to "sign":

Click here to acknnowledge that you have read and agree to BeOnTheNet's Terms of Sale.

***Terms of Service***
Please read before continuing.
Click here to "sign":

We appreciate the trust you have placed in us. Our goal at BeOnTheNet (R) to provide you, our clients with the highest level of value and service possible.

For feedback please email to: feedback@beonthenet.com

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