Use this form to submit a special payment to AMS Computer Services.

Customer Information
Your Name:
Company Name:
(if applicable)
E-mail Address:
Domain Name:
Address:
City:
State:
Zip Code:
Country:
Telephone:
Fax:
(if applicable)
Payment Type
Payment Method:
Credit Card Information
Credit Card: Mastercard Visa American Express Discover Other
Card Number:
CVV (optional)?:
(Leave this blank unless your bank specifically requires this)
Card Expiration:
Name on Card:
Address of Cardholder:
(if different from above)
PayPal Information
You have chosen to pay with PayPal. You will be redirected to a PayPal payment page after you submit this form. Payment will be made to AMS Computer Services, Inc
Payment Information
Payment For:Web Hosting Domain Name Registration/Renewal Other
Recurring Payment?Yes - Make this a recurring subscription No - Make this a one time payment
Payment Amount: USD
Comments or Special Instructions