Order PositiveSSL Certificate Use this form to submit a special payment to AMS Computer Services. * Domain name must be set up on an AMS web server! Certificate InformationThis information will be tied to your certificateThis is a new certificateThis is a certificate renewal Domain Name for Certificate: Certificate Validation Period:1 Year Company Name: Company Division: City of Company: State of Company (Full Name): Country of Company (2 Letter Abbr.): Certificate Email Address: Payment Information Stated Price:$18.95 - USD Your Name: Email Confirmation: Payment Type: Credit Card Number: CVC: Credit Card Expiration: January - 01 February - 02 March - 03 April - 04 May - 05 June - 06 July - 07 August - 08 September - 09 October - 10 November - 11 December - 12 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 Name on Card: Street Address of Cardholder: Zip Code of Cardholder: Comments or Special Instructions THIS CHARGE IS NON-REFUNDABLE! Please be sure that the Domain Name for this certificate is correct!